Tuesday, 5 February 2019
Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions
Drug Treatment Programmes
44. To ask the Minister for Health when the protocols on the methadone strategy were last reviewed; if he is satisfied that there are sufficient progression pathways for persons on the methadone programme to become drug free; and if he will make a statement on the matter. [5520/19]
When were the protocols regarding methadone treatment last reviewed? Is the Minister of State satisfied with the progression pathways available and are they are sufficient to ensure that those who want to progress from the methadone programme to become drug free can do so?
Methadone prescribing for opioid dependence is a key element of the harm reduction approach to opioid use set out in the national drugs strategy. Methadone is one of the medications used in opioid substitution treatment, along with Suboxone.
As of 30 November 2018, more than 10,000 people were in receipt of methadone maintenance treatment.
The HSE provides opioid substitution treatment in a number of treatment settings to meet the needs of individual drug users, including primary care, treatment centres and residential facilities.
Since 2016, an additional 350 treatment episodes have been provided in tier 4 residential centres at a cost of €2.15 million. Within the past year, the HSE has established services in south Tipperary, Wexford and Limerick, and a service in the midlands opened in September.
A review of the methadone treatment protocol was published in December 2010. Arising from the review, the HSE implemented an opioid treatment protocol to provide appropriate and timely substance treatment and rehabilitation services tailored to individual needs.
In 2016, the HSE published clinical guidelines for opioid substitution treatment. The guidelines are the first that specifically relate to opioid substitution treatment in HSE clinics and primary care settings.
Opioid substitution treatment supports patients to recover from drug dependence. HSE addiction services work within the national drugs rehabilitation framework to support progression pathways.
The framework ensures that individuals affected by drug misuse are offered a range of integrated options tailored to meet their needs and to create rehabilitation pathways.
Methadone treatment reflects the public health approach to drug and alcohol misuse set out in the national drugs strategy. Moreover, it is an important tool to reduce harm and to aid people to recover from drug use. I am committed to improving the availability of this treatment and to developing services to meet the needs of people on opioid substitution treatment.
I thank the Minister of State for her reply. I recognise that methadone has a significant role to play in harm reduction, be it in respect of health, criminal activity and so on, and I do not dispute that. My concern, and the purpose of the question, is that more than 10,000 people are currently on a methadone treatment programme, as she indicated. More than 6,000 have been on it for five years or more, while more than 4,000 are on methadone for ten years or more. Since 2016, between 70 and 80 teenagers have been on a treatment programme. I am concerned that some people seem to remain on a programme for a long time. There must be better outcomes. The Minister of State referred to a 2010 review. In 2019, it is time we reviewed it again, knowing that people are on this programme indefinitely. Are we suggesting to somebody who goes on such a programme when he or she is aged 17, 18 or 19 that he or she will still be on methadone treatment in ten or 15 years? There has to be a better outcome and the figures indicate that some people are on the programme way too long.
I agree with the Deputy in raising the issue here and in looking at how we can proceed at looking at another programme to identify the length of time people are on methadone. As he said, people are on methadone over a long period. Some of them have been on it for more than then ten years. For many, it is an opportunity to remain stable and to continue their lives and work. I know many of these people. There are limitations, however, in the opportunities for GPs in areas with regard to methadone services. A number of doctors are available for level 1 and level 2 GP services. There are, however, problems recruiting doctors for level 2 GP services for methadone treatment. We are succeeding around the State and with the funding made available through the HSE for services in primary and community care, I believe there will be an outcome into the future.
Suboxone use has also been established as a treatment in Ireland. To facilitate the increase in the use of Suboxone, €750,000 was allocated in each of the years 2017 and 2018, giving us a sum of €1.5 million for the full year costs. Suboxone is a new initiative in Ireland to help some people, while others will never be on Suboxone because that treatment does not suit them. We will continue to roll out the Suboxone treatment.
I agree with the Deputy that it is a while since the 2010 review of the treatment programme and that we may need to look at it again. People are, however, surviving on a daily basis, living out their lives, going to work and rearing families while they are on methadone. We cannot forget the fact that it is also available.
I do not suggest that one size fits all but I am concerned that more than 4,000 people are on a methadone programme for longer than ten years. When a person goes onto the programme, there needs to be personal plan for those who are suited to it to progress beyond a life on methadone. For some of those people it is a life on methadone.
I welcome the Minister of State's comments on Suboxone. Ireland, however, is a bit of an outlier in comparison with most European countries that have 20% or 30% of those on opioid substitution treatment, OST, using Suboxone. We have a very small cohort. This is not the same as in Europe. Suboxone has a lot of benefits. It is less addictive and easier to withdraw from, there is less chance of overdosing, and so on. The roll-out of Suboxone in Ireland for those who could benefit from it has been slow.
We often talk about the risks of taking somebody off methadone. There are risks also for people who remain on methadone. The drug-related death index shows there are some 700 drug-related deaths per annum, half of which are from poisonings. Approximately 20% of those who are poisoned have been in receipt of methadone. That means 1% of the population that receives methadone treatment per annum is dying. The treatment programme needs to be reviewed with personal progression plans being considered and the alternative Suboxone being made more widely available.
I agree with the Deputy that there is a small percentage of people on Suboxone, but we are heading in the right direction. We have had additional funding this year to roll it out further. We will do that. Under the new strategy it is very clear to me and my Department that we will have to evaluate some of the methadone treatment numbers to see what we can do in the future to help people to reduce the time they are on the programme. We need more GPs to come on board, especially in level 2 GP services, to help with chronic people coming into clinics. This can also be the first port of call for them. We are approaching the issue in the right way. We may differ in how quickly we can get through it but I agree there needs to be a review. It has been a long time since the methadone treatment services were reviewed in 2010. There are a lot of good services in the community, in pharmacies and GP practices, and they have made a significant difference to peoples' lives. I know we are not knocking it, but I do not believe we should constantly target those people who are making a major recovery because they have been on methadone, even for a short time.