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  • Drug Addiction Treatment and Rehabilitation

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  • Table of Contents

    Page

    Summary of Findings 9 Drug Addiction Treatment and Rehabilitation 1 Introduction 17

    2 Demand for Addiction Treatment 23

    3 Care Planning and Management 29 4 Treatment of Opiate Addiction 37 5 Treatment of Non-Opiate Addiction 49 6 Addiction Treatment in the Criminal Justice System 57 7 Social Support and Reintegration 69 8 Co-ordination and Monitoring of Strategy 77 Appendices A Summary of the effects and use patterns of the most frequently used illicit drugs 87 B National Drugs Strategy actions on treatment, rehabilitation and risk reduction 89 C Last year prevalence rates for drug misuse in EU member states 92 D National Drug Treatment Reporting System case reporting form 94

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  • Abbreviations CTL Central Treatment List

    FÁS Foras Áiseanna Saothar/Training and Employment Authority

    GP General Practitioner

    HSE Health Services Executive

    NACD National Advisory Committee on Drugs

    NDST National Drugs Strategy Team

    NDTRS National Drug Treatment Reporting System

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  • Summary of Findings

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  • Summary of Findings Drug addiction treatment and rehabilitation services are provided through a wide range of publicly-funded agencies. These include the Health Service Executive (HSE), community-based GPs and pharmacies under contract to the HSE, a range of community and voluntary groups, parts of the criminal justice system and FÁS. In addition, 24 area-based drugs task forces are involved in planning and coordination of drug-related services in their respective areas.

    Strategic objectives for drug addiction treatment and rehabilitation service delivery were set in the National Drugs Strategy 2001-2008. These were to encourage and enable those dependent on drugs to avail of treatment, with the aim of reducing

    drug dependency and improving overall health and social well-being and, ultimately, leading a drug-free lifestyle

    to minimise the harm to those who continue to engage in drug-taking activities that put them at risk.

    A number of government departments have functions in this area. The Department of Community, Rural and Gaeltacht Affairs has overall responsibility for coordinating the implementation of the National Drugs Strategy, and has established a number of coordination structures. The Department of Health and Children is responsible for the national policy on drug misuse treatment generally. The Department of Justice, Equality and Law Reform has responsibility for policy in dealing with drug treatment provision in the prison and probation systems.

    This examination looked at all the main publicly-funded treatment and rehabilitation services provided for persons with addiction to illegal drugs (mainly cannabis, cocaine, ecstasy and heroin). In particular, it looked at the extent to which the demand for treatment and rehabilitation services is met, and the timeliness of access to treatment. It also looked at the extent to which the effectiveness of treatment and rehabilitation services are evaluated, and the effectiveness of the arrangements for coordination of treatment and rehabilitation at an individual case level, and nationally.

    Delivery of Treatment

    Treatment for Opiate Drug Use

    It has been estimated that less than 0.5% of the population use opiates of which heroin is the most commonly used. In the past, its use was concentrated in the greater Dublin area, but there is evidence that the use of heroin has increased in other areas in recent years.

    Methadone-based substitution treatment is the main form of treatment for heroin addiction. At end 2007, just over 8,000 people were receiving methadone treatment. Around one third of these are treated under the supervision of community-based GPs.

    Needle exchange services are provided in some areas with the aim of reducing the risks associated with the sharing of injecting equipment. While there was some increase in the provision of needle exchange services over the life of the Strategy, gaps in service provision remain.

    Detoxification treatment for opiate users and follow-on rehabilitation treatment levels are very low, when compared to the numbers receiving methadone treatment. It is estimated the annual level of detoxification treatment is in the region of 100 courses of treatment, at most — around 1.25% of those receiving methadone treatment.

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  • 10 Drug Addiction Treatment and Rehabilitation

    While long-term methadone maintenance is likely to be the best outcome that can be achieved for a significant proportion of heroin users, it would be desirable that the HSE would set target rates of progression through the various forms of treatment. Service capacity planning could then be based on what is required to meet the progression targets.

    Treatment for Non-Opiate Drug Use

    The prevalence of cannabis and cocaine use among the general population is increasing. The habitual use of a number of drugs at the same time is also on the increase. Despite this, there does not appear to have been a commensurate increase in the number of cases treated for problem use of non opiate drugs over the life of the National Drugs Strategy.

    Changes in the pattern of drug misuse creates a challenge for service providers to reconfigure a system geared predominantly to dealing with one drug type in a defined area (e.g. heroin addiction in the greater Dublin area), to one that is capable of dealing with different kinds of addiction in different areas and increasingly, with clients with multiple addictions. The current pattern of drug use suggest that there are, in effect, two separate contexts in which drug treatment has to be provided

    a largely opiate-based addiction problem, concentrated in certain marginalised and poor sectors of society, and in certain geographic areas

    problem use of non-opiate drugs, spread more widely across social groups and geographic areas, and where many of those being treated may have access to more social supports and economic resources.

    Although there is a higher prevalence of misuse of all kinds of non-opiate drugs in the greater Dublin area than in the rest of the country, the rate at which users of non-opiate drugs in Dublin enter treatment appears to be significantly lower than for the population elsewhere. There is a risk that this pattern derives from the available facilities and the priorities in the two areas rather than the objective need of the populations served.

    While there may be overlaps between the two populations of drug users, the future management of service delivery appears to demand differentiation in targets set, performance measures used and performance reporting.

    Demand for Treatment

    Information about the level of demand for treatment for problem drug use is very important for service planning purposes, but is incomplete.

    A database on treated drug (and alcohol) use in Ireland is compiled and managed by the Health Research Board (HRB). This database, the National Drug Treatment Reporting System (NDTRS) relies on treatment service providers to collect details on each individual who presents for treatment. The information is transmitted to the HRB, but without the personal identification details (e.g. name or address) of the individuals receiving treatment. The result is that while the number of courses of treatment delivered can be identified, it is not possible to track the progression of an individual from one service provider to another.

    The NDTRS has the potential to generate better estimates of demand for treatment, but greater compliance by service providers with the NDTRS data input rules would be required if this is to be achieved.

    In the case of methadone treatment, delivery is recorded on a Central Treatment List, which is a statutory register of all patients receiving methadone as an opiate substitute in Ireland.

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  • Summary of Findings 11

    Ways of recording treatments sought and provided on an individual basis and in a manner that ensures security of the information need to be established. This should be tackled by the HRB in liaison with service providers and with the Data Protection Commissioner. In this context, consideration could be given to upgrading the current NDTRS case recording and reporting system, perhaps moving to an internet-based system.

    Access to Treatment

    This examination found that the NDTRS data may underestimate the extent of waiting for assessment. The practice in some areas is that recording of information for NDTRS purposes starts only at the time of assessment, rather than at th

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