Minister of State John Curran T.D. Launches Annual “Getting a Grip” Conference

Posted on 09/10/09 by John Curran Thank you for inviting me here this morning. This is my second time to attend this conference and much has happened in the intervening year, not least the launch of the National Drug Strategy 2009 - 2016 by the Taoiseach last month.

It is an "interim" policy pending the development of the broader Substance Misuse Strategy that is to be formulated in accordance with the Government decision of 31 March to include alcohol and drugs in a combined National Substance Misuse Policy. While mainly addressing the drugs issue, the new Strategy, also covers the responses required to deal with aspects of the prevalence of problem alcohol use particularly in the areas of treatment, rehabilitation and prevention.

The theme of this year's conference "Reducing Drug and Alcohol Related Harm" is both appropriate and timely and is reflective of the need to address problem substance use in our society.

Current Context

While illegal drug use continues to be predominantly a younger adult phenomenon, with those under 35 accounting for the bulk of usage and males being twice as likely to use drugs as females, problem alcohol use occurs across all strata of Irish life.

With respect to illegal drug use, the indications are that the use of heroin is relatively stable in the Dublin region. The rate of new entrants to treatment dropped by approximately 20% between 2001/2002 and 2006/2007 and the average age of those in treatment has increased from 28 in 2001 to 33 in 2008. However, it is clear that heroin has become more widely dispersed around the country. Heroin is still a very significant problem and responding to it remains as a fundamental element of the new Strategy.

As in other Western European countries, the use of cocaine has increased significantly across all social strata, though from a low base. While it is a countrywide problem, again it is most prevalent in Dublin and in the East and South of the country. So-called "recreational" use of cocaine is a real problem and it is vital that the consequences of such usage for communities and for wider society are clearly brought home to those who see their use of the drug as a purely private matter.

Polysubstance use is now the norm among those who take drugs, with over 70% of those presenting to treatment services being poly-substance users. The use of two or more substances, often including alcohol, presents substantial risks to those involved, as well as increased challenges for treatment personnel. It is also worth mentioning that there are also concerns about the misuse of prescription drugs and over-the counter drugs.

The numbers using illegal drugs compared to the numbers using alcohol on either a recent (last year) or a current (last month) basis is relatively low. The last National Prevalence Survey 2006/07 indicated that just over 73% of the population used alcohol in the last month, while approximately 3% used illegal drugs, mainly cannabis. These figures give some idea of the different scales involved with regard to problem alcohol use and illegal drug use.

We are all aware that alcohol use is interwoven into the social fabric of our society and its sensible moderate use is not what concerns us. What is of concern is the problem use of alcohol and key concerns relate to underage drinking, binge drinking among young adults leading to potential public order problems and the levels of excessive drinking at all ages that can give rise to significant health problems for the individuals involved.

Although the annual number of alcohol-related hospital discharges has been relatively stable this decade, the seriousness of the alcohol problem facing us is illustrated by the virtual doubling of the level of these discharges since the mid 1990s. Not only have the number of cases increased but the severity of the cases being treated has also increased with chronic cases virtually doubling and liver cases trebling in this period.

The figures outlined illustrate the severity of the problems facing us and the pressing need for our strategies to be effective.

New Strategy
The National Drugs Strategy 2009-2016 will continue to use the 5 pillar approach of supply reduction, prevention, treatment, rehabilitation and research that was used in the last Strategy. This approach has proved successful and it is broadly in line with the EU Action Plan on Drugs for 2009-2012. I want to concentrate on the prevention, treatment and rehabilitation elements today.

Prevention
I am committed to implementing strong prevention measures in a real effort to move people away from becoming involved in drug use, thus avoiding many problems for all of society. This will involve varying degrees of intervention, involving a "light touch" for the general population who are less at risk, up to concerted effort in the case of younger people in at risk categories.
Interventions will fall under the following broad headings:
•    Universal prevention programmes aimed at reaching the general population. Measures often associated with this type of programme include awareness campaigns, school drug/alcohol education programmes and multi-component community initiatives.
•    Selected secondary prevention programmes aimed at groups at risk, as well as subsets of the general population including children of drug users, early school leavers and those involved in anti-social behaviour. These programmes will aim to reduce the effect of risk factors by building on strengths and developing resilience and protective factors.
•    Targeted tertiary prevention programmes aimed at people who have already started using drugs/alcohol, or who are likely to engage in problematic drug/alcohol use or to prevent relapse. These require individual or small group programmes aimed at addressing specific needs.

The further development of prevention measures aimed primarily at those deemed to be most at risk of becoming involved in illegal drug use, and at the younger adult population generally, is a crucial element of the new Strategy. The role of the Office of Minister for Children and Youth Affairs (OMCYA) will be crucial to much in this regard, but particularly in reference to secondary programmes as he has overall responsibility for the various youth services involved. I believe that the early use of alcohol acts as a gateway drug to illegal drug use and a focus on prevention with respect to early substance use is a critical component of the new Strategy.

In the school setting, the Walk Tall and Social Personal Health Education (SPHE) programmes, at Primary and Second Level respectively, are generally agreed to be conceptually sound and in line with the best evidence-based practice on prevention. The challenge is to deliver these programmes in the most effective way, across the whole school environment, to better equip all our children to handle the real dangers that they will face.

Early School Leaving has been identified as a key issue within the broader Social Inclusion agenda as set out in Towards 2016 and it is also an important issue in terms of the onset of early problem substance use. Over the past number of years the Department of Education & Science has developed a significant range of measures aimed at improving school outcomes. While this is showing some positive results, it is important that the effort continues.
Indeed, many of the risk factors around problem drug use are being addressed within the broader Social Inclusion agenda. The role of the National Drug Strategy in many cases is to complement the actions developed to respond to these issues. It is also important to enhance the protective factors that help to prevent early onset of problem substance use. These relate in the main to family and educational factors. All relevant agencies most work towards the co-ordination of the efforts to boost the life skills, confidence and social competence of individuals in our society.

Meanwhile, under the new Strategy, efforts to raise the awareness of the general public to the dangers of problem substance abuse will aim to make people, particularly younger adults and their parents, more informed about the personal and societal consequences of problem substance use.

Treatment and Rehabilitation
There has been very significant progress in the range and quality of drug treatment services available. However, the new Strategy recognises that there is a need to develop these into a comprehensive integrated nationwide service. This will involve the development of the range of options available, from substitute treatments through other harm reduction approaches to drug free approaches.
I might also mention the role that families can often play in the recovery process. Treatment outcomes tend to be most successful with family support and this something that I intend to facilitate further under the new Strategy.
The numbers on methadone treatment for heroin addiction has increased substantially to nearly 9,000 people. Getting people into treatment, and retaining them in treatment, has been a significant success under the previous Strategy. Having said that, I have asked that the Methadone Implementation Committee look further at the potential for facilitating the progression of more people from methadone to a drugs-free lifestyle. While methadone treatment has been very beneficial, and many will continue to use it on a long-term basis, I feel that the possibilities for people to progress to a drugs-free lifestyle should be explored. We should work towards that objective if the advice to me indicates that this is a feasible approach.
Notwithstanding the expansion achieved, I accept that it is now necessary to have services available to people right around the country. As a step towards addressing this, I have allocated capital funding of €1.1 million towards the development of treatment clinics in Limerick, Cork, Waterford, Enniscorthy, Drogheda and Dundalk to help to address these shortcomings. I have stressed the urgency involved in providing these facilities and I am assured that some of them will be in operation by the end of the year, with treatment being available in all six locations early in 2010.
While, the number of GPs and pharmacies involved with the service has increased over this decade, there is still a need for more to become involved, especially in regard to GPs outside the Dublin region. While I acknowledge the significant efforts being made by the HSE, the Irish College of General Practitioners and the Irish Pharmacy Union, all of whom I have met in recent times, to further improve the availability of services, I will continue to press for the achievement of results on the ground. At the same time, I will be happy to do whatever I can to expedite progress within the context of the new Strategy.
Overall, I believe that the future development of services must be based on having in place a system that guarantees a continuum of care for people presenting for treatment and rehabilitation. The development of integrated service provision and enhanced inter-agency working between the statutory, voluntary and community services is fundamental to achieving successful outcomes.

The work of the National Drug Rehabilitation Implementation Committee, which is chaired by the HSE and which is responsible for overseeing and monitoring the implementation of the recommendations of the Report of the Working Group on Drugs Rehabilitation, will be most important in this regard. Their work will cover the development of protocols, service level agreements, case management, quality standards and training in regard to drug rehabilitation and the inter-agency working that is crucial to achieving optimum outcomes for the people involved.

Indeed, I recently set up a group of representatives from the statutory and voluntary sectors involved in residential rehabilitation with a view to kick-starting the fuller integration of services. Their work will be continued over a short period with a focus on achieving real steps forward for those endeavouring to pursue a drug free lifestyle.

Other key treatment issues under the new Strategy include:
•    the use of a 4-tier model approach, with treatment available at the level appropriate to the needs of individuals, underpinned by an appropriate clinical governance framework;

•    initiatives focused on the prevention and treatment of blood borne viruses, particularly HEP C;

•    continued development of treatment services in prisons and ensuring a continuum of care for people on release;

•    the development of an Overdose Prevention Strategy, responding to outcomes of the National Drug-related Deaths Index;

•    the further expansion of family support services; and

•    an increased focus on at risk groups such as under 18s, new communities, Travellers, the Lesbian Gay Bisexual and Transgender community, homeless people and sex workers.

Conclusion
As many of you know, Office of the Minister for Drugs (OMD) has been established to subsume the functions previously undertaken by the National Drugs Strategy Team and the Drugs Strategy Unit of my Department. I intend that the new Office will bring a renewed vigour to the effort against drugs and build on the achievements made to date.

 

In implementing the National Drugs Strategy 2009-2016, improved performance will have to be achieved in a situation of limited resources. Thus, the optimum use of the funds allocated to tackling the drugs problem across the different Departments and agencies involved is imperative (the total for 2009 is approximately €270m). With the greater inter-agency working envisaged across all sectors, I am confident that this is achievable.

I am determined to tackle the issue of problem substance use over the coming years and I believe the new National Drugs Strategy will facilitate this. I will also be ensuring that work presses ahead on the development of a National Substance Misuse Strategy, incorporating alcohol issues, by the end of next year.

I applaud events such as your conference here in Killarney. The holding of such events illustrates the nationwide extent of the drugs and alcohol problems and I hope that, through the formal deliberations, and the broader sharing of ideas, that it plays some small part in preventing problems for individuals and their families.