SOME DRUG USERS SUFFER WITH NEW REGULATIONS

A new addiction treatment system has stopped the flow of methadone on to the
streets, but not without casualties, reports CATHERINE CLEARY, Drugs and
Crime Correspondent

Dublin is a more difficult place to be a opiate addict than it was four
months ago. The street price of heroin has doubled and blackmarket
methadone, the legal substitute that was sold widely on the streets, is now
a scarce commodity.

On the surface both changes appear to be welcome developments. Higher prices
mean fewer new users, in the eyes of some policymakers. Heroin that sold for
IEP10 a bag four months ago now costs IEP20.

The flood of State-sponsored methadone on to the streets was a disturbing
side-effect of the heroin epidemic. Before new Department of Health
regulations came into effect on October 1st, there was nothing to prevent an
addict going to more than one GP and getting multiple prescriptions. Gardai
regularly seized litre bottles of physeptone, the brown linctus form of
methadone, when they raided dealers. Large quantities of methadone were
dispensed to chronic addicts who were then expected to self-administer small
amounts daily. Some doctors were prescribing methadone to hundreds of
addicts, without testing whether they were also using drugs. Since October
1st methadone can be dispensed only to an addict who carries an identity
card, is referred by a registered clinic to a GP and is registered on a
central treatment list. Brown physeptone has been phased out and green
methadone, a more concentrated opiate, is now taken orally at treatment
centres.

However, the transition to a more regulated methadone service has not been
easy. Although the Eastern Health Board has doubled its number of
methadone-treatment places in the last two years, waiting lists have not
decreased, and all drug services are swamped.

Those suffering most from the system, called the methadone protocol, are
addicts who found themselves cut off from their supply when the rules came
in.

A second group is also suffering. A small number of users who combined a
private addiction to methadone with a stable life have found themselves
catapulted into a public system.

An EHB spokeswoman insists that no addicts were "thrown out on the streets"
when the protocol came in. By the end of last month there were 455 people
(176 women and 279 men) waiting to get on treatment programmes in the EHB
area. But the spokeswoman argues this number does not represent people who
lost their methadone supply on October 1st. They are new users looking for
treatment, she says. "For the people whom GPs notified to us we actually
arranged specifically for those to be included in the new services provided.
An additional 600 were notified to us and our priority was to see that they
were treated."

However, the health board has no idea how many addicts, whose names were not
among those 600, found themselves cut off from their methadone supply. Mr
Pat McLoughlin, the EHB chief executive and former programme manager for
addiction and social development, argues the protocol is

working. "It had the impact of bringing more and more people out of the
woodwork," he says.

"A couple of GPs didn't co-operate with us so it meant right up to 1st of
October we didn't have details of how many we'd have to be able to provide
treatment for."

It is those people who appear to have fallen through the cracks, many of
them returning to illegal drug use.

Ms Anna Quigley, of the community group Citywide, says there has been a
"serious underestimation of the number of drug users on treatment". The
protocol is "absolutely right", in principle, she says, but could have been
introduced much more easily.

"Before the protocol you might have one person receiving methadone from a
doctor, but supplying two or three other people, like a partner or brothers
and sisters. So for one name on the register you might have had two or three
being maintained. As a result, a lot of these people have had huge problems
accessing services."

A significant obstacle to getting drug services up and running in time for
the October 1st deadline was the resistance of local communities to having a
drug treatment centre in their areas. The EHB is considering establishing a
second centre in the north inner city to take pressure off the City Clinic.

By the end of the year the number of clinics should have increased from 42
to 50, pending planning permission and agreement from communities. In 1997,
the EHB treated 3,574 addicts. By the end of last month the central
treatment list was 3,610. Ninety seven GPs are now registered to prescribe
methadone and 144 pharmacies are dispensing, an increase of 72 in the last
year. GPs must be trained and are limited in the number of addicts they can
take on. The limit is between 15 and 35 addicts, depending on the level of
training.

A stabilisation unit is planned for Cherry Orchard and a 20-bed
rehabilitation unit is to be set up in St Mary's in the Phoenix Park. Both
developments have been planned since 1997.

Huge Garda seizures have played a part in the economics of Dublin's heroin
supply, with a pre-Christmas drought forcing prices up. But heroin dealers
also no longer have to compete to the same extent with black market
methadone dealers.

Another major problem has been for those addicts whose addiction was catered
for by a weekly or fortnightly prescription. Ms Quigley says some people who
were holding down a job have found the new rules extremely disruptive. "Once
they were registered they were required to go every second day."

Mr McLoughlin says the priority now is "to get as many of the people who are
stabilised in the clinics back to their GPs". The protocol has succeeded in
getting between four and six GPs that were seen to be prescribing
inappropriately out of the system. Ms Quigley believes it will work. But
there was "no need for the implementation of the protocol to be this
difficult."

With better planning and consultation with communities and drug users, the
system could have been put in place without the amount of chaos it has
caused, she says. "The people who are caught in the middle of it are drug
users. If you tried to do that in any other area of medical care there would
be uproar."