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Saturday 25 November 2017

State-sponsored heroin addicts costing us €20m

Annual taxpayers' bill for opiate substitute methadone is revealed as the HSE prepares to unroll a programme supply the drug nationwide

Jerome Reilly

Jerome Reilly

More than 11,000 drug addicts are now being given the heroin substitute methadone as the HSE prepares to roll out new services to supply the replacement drug around the country.

It's costing nearly €20m a year to provide the substitute to heroin addicts.

In north Dublin, including the city centre, it costs €7,034 per patient each year to provide methadone and clinical support. The high cost is because many addicts in these areas have particularly chaotic lifestyles and require intensive high-level support.

In other areas around the country, for example, the south east, the cost per patient falls to €2,769 a year because the service provided is mainly a scripting clinic without the high level of clinical support.

As well as dedicated methadone clinics, GPs and pharmacists also administer methadone. Approximately one-third of patients receive methadone from about 500 pharmacies around the country, based on 2008 figures.

Pharmacists who provide methadone may apply for a grant of up to €6,350 under the Methadone Scheme if they wish. This grant is to assist pharmacists with providing an adequate safe for storage, providing a suitable private area within the pharmacy, and improving security.

But the HSE is now going to provide additional methadone services in Wexford, Waterford, Kilkenny, Cork, Kerry, Limerick and Louth as a debate begins over the use of methadone as a long-term treatment for heroin addicts.

In all, 80 per cent of heroin abusers who are fighting their addiction are being prescribed methadone.

Research seen by the Sunday Independent suggests that heroin has become a scourge around the country, hitting small towns and villages as well as the big urban areas.

A report by the Midland Regional Drugs Task Force found evidence that heroin users who want to get off the drug are facing chronic problems accessing methadone in Offaly, Laois, Longford and Westmeath.

The paper titled Close to Home found that local drug markets had created an atmosphere of "fear and intimidation."

The report found that in the four midlands counties, 76 people died from taking drugs in just six years between 1999 and 2005, and since those figures were collated there has been a massive increase in the use of opiates.

The report identified two medium-sized towns in Laois and Westmeath, a small town in Longford and a rural community in Offaly where heroin was on the increase.

Dr Garrett McGovern, a Dublin GP who has specialised in clinical addiction for more than a decade, said last month that heroin addiction was spiralling out of control in many counties.

He pinpointed Wexford and Kildare as two areas with significant heroin addiction problems but with little options for treatment. Consultant psychiatrist Dr Moosajee Bhamjee said that using methadone for the vast majority of heroin addicts is simply replacing one illegal addiction with a legally prescribed one.

In correspondence with the Irish Medical Times, Dr Bhamjee argued that originally methadone was to be prescribed for only a minority of 10 per cent of heroin addicts

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but at present it is prescribe to the vast majority. Dr Bhamjee, a former Labour TD, criticised the current regime where individuals are not detoxed from mood-altering substances and no abstinence rehab programme is instituted.

"Thus, the continuous prescribing of a severe addictive substance [methadone] from which it is difficult to abstain is continued for life. This is wrong; we should take people off methadone.

"Ireland needs a proper addiction policy with detox facilities and rehab units," Dr Bhamjee wrote. But his views have sparked controversy.

Dr Cathal O Suilliobhain, an acknowledged expert on substance abuse, argued that methadone is a proven and cost-effective treatment for heroin addiction. Dr O Suilliobhain wrote: "It is true that it is difficult to stop heroin use but there is absolutely no evidence to indicate that in-patient detoxification produces any better medium- or long-term outcomes in terms of sustained abstinence than does outpatient treatment.

"The evidence on drug-free residential rehab facilities is woolly, to say the least."

Dr O Suilliobhain warned that short inpatient detoxes also increase the risk of death by overdose on discharge due to loss of opioid tolerance.

"The benefits of properly delivered methadone treatment -- reduction of death, improved general health, decreased criminality, improved family/ social relationships -- are validated by volumes of peer-reviewed research evidence," he added.

In a report to the Dail Public Accounts Committee last year, the HSE provided additional information on current policies regarding the provision of methadone.

The report stated: "The provision of methadone to those assessed as appropriate for it, is an internationally recognised approach as a medium- to longer-term response that achieves stabilisation, independent functioning and normal living for clients who would otherwise be incapable of living with their addiction."

The HSE recently asked Prof Joe Barry to review methadone protocols.

Sunday Independent

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