Lynn Ruane (Independent) | Oireachtas source

I move amendment No. 1:

In page 11, between lines 17 and 18, to insert the following: “(I) in subparagraph (ii), after “or class of medicinal products,”, by the insertion of “to include Opioid Substitution Treatments,”,”.

This is much in the same vein as the conversation we had last week, and I note we have not had much time in between to converse on it. To reiterate the points I made on the previous Stage, this amendment would insert an explicit reference in the Bill to the capability of registered nurses to prescribe opioid substitution treatments, OST. Legislation was introduced in 2006 to facilitate nurse prescribing of certain medications, including opiates, in a range of clinical areas, but not for the purpose of drug treatment. Nurse prescribing of OST is a safe and effective mechanism and has the potential to significantly expand access to drug treatment, lifting people out of active and acute drug addiction and saving lives in the process. Nurse prescribing for OST is an established practice in other jurisdictions, including Northern Ireland, Great Britain, the Netherlands, the United States and Australia.

The national drug strategy 2017-2025 commits to improving the availability of OST, also referred to as OAT, by examining potential mechanisms to increase access to the expansion of GP prescribing and nurse-led prescribing and through the provision of OAT in community-based settings and homeless services. Despite this fact, in response to a recent parliamentary question tabled by Deputy Gould, the Minister of State in the Department of Health stated there is currently no objective need for the introduction of nurse prescribing of OST or OAT. Perhaps the Minister in his reply would provide a little more context to understand how this need has been determined.

According to the 2023 Focal Point Ireland report on drug treatment, opioids were the second most common main problem drug reported in 2022 at 33.1% of all cases treated, overtaken by cocaine for the first time. Heroin accounted for 86.6% of these opioid cases. Outpatient OST and OAT for people with problem opioid use is presently provided only through specialised HSE outpatient drug treatment clinics, satellite clinics or specialised general practitioners in the community. Because of this, waiting lists for access to treatment are not at all unusual, particularly in many of our rural communities. Allowing nurses to prescribe OST would cut, and potentially even eliminate, waiting times and ensure a more holistic and rehabilitative response to treatment of addiction.

According to reporting in The Irish Times informed by HSE and Health Research Board, HRB, data, 70 people were waiting to be entered onto the central treatment list for OST in November 2022. From referral to assessment, the average waiting time nationally is 4.9 days. However, this ranges from less than a day in the mid-west to 12.7 days in the south east. After assessment, waiting times for the commencement of treatment outside Dublin can be as long as three months.

In a report in 2022 regarding an examination of the present approach to sanctions for possession of certain amounts of drugs for personal use, the Oireachtas Joint Committee on Justice made two key recommendations relating to OST. The first was for the Department of Health to support the continued expansion of Ireland’s opioid substitution treatment, OST, programme to ensure the treatment is more widely available to communities across the country. The second recommendation was to undertake an evaluation regarding the role that non-medical prescribers could play in treating opioid addiction in Ireland by increasing access to OST. Have any actions have been taken within the Minister's Department to give effect to these recommendations?

According to Dr. Peter Kelly, assistant professor in mental health nursing at Trinity College Dublin, implemented nurse prescribing of OST was recommended for Irish services by Professors Michael Farrell and Joe Barry in the 2010 independent review of the opiate treatment protocol with a view to expanding the availability of OST and in keeping with international best practice. Further, a 2023 review of empirical literature authored by Banka-Cullen identified that this model of prescribing is effective in increasing the numbers in OST treatment, especially for more deprived populations and in rural communities.

While the Minister may not be in a position to accept this amendment today, I urge him and his department officials to take the requisite steps to facilitate nurse prescribing of OST in Ireland as a matter of urgency. On a practical point related to empowering and expanding the role of nurses in respect of prescription of OST, we often look to the waiting lists as the reason that something should be expanded. However, on a practical level, within doctors' surgeries, clinics, community care teams and hostels, it will often be found that nurses are present to a greater degree than doctors, even in the waiting room. Many of the people I support who are on long-time opioid methadone treatment could often be left sitting in a waiting room in their doctor’s surgery for up to two or three hours, waiting to go in to see their doctor to receive what is a weekly prescription for methadone.Nurses should be empowered in this regard to make the experience a much better one for people instead of leaving them sitting around waiting, when nurses are there, ready and able to prescribe, if the legislation saw fit to allow them do so.