Drug Addiction Treatment and Rehabilitation

96 Pages·2009·1.85 MB·English

Comptroller and Auditor General
Special Report

Department of Community, R ural and Gaeltacht Affairs

Drug AddictionTreatme nt and Rehabilitation

March 2009
© Government of Ireland 2009

This report was prepared on the basis of information, documentation and
explanations obtained from the public bodies referred to in the report. The draft
report was sent to the HealthService Executive, the Courts Service, FÁS and
the departments of Community, Rural and Gaeltacht Affairs, Justice, Equality
and Law Reform and Health and Children. Where appropriate, the comments
received were incorporated in the final version of the report.
Report of the Comptroller and Auditor General

Drug Addiction Treatment and Rehabilitation

I have, in accordance with the provisions of Section 9 of the Comptroller and Auditor General (Amendment)
Act, 1993, carried out an examination of the publicly-funded treatment and rehabilitation services provided
for persons with drug addictions.

I hereby submit my report on the above examination for presentation to Dáil Éireann pursuant to Section 11
of the said Act.

John Buckley
Comptroller and Auditor General

13 March 2009

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
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
Summary of Findings

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
(cid:132) 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
(cid:132) 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.
10 (cid:132) 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
(cid:132) a largely opiate-based addiction problem, concentrated in certain marginalised and poor sectors
of society, and in certain geographic areas
(cid:132) 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.