Opiate Substitution of Heroin

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Government ignores statistics in Heroin related Deaths.

The government is ignoring statistics that the current opiate substitution
treatment of Heroin is not working and is actively contributing to further
death in our society.

“People recognise that drugs are not really on the agenda with the Government.”

"The government will put the money into methadone because it keeps people stable and
they’re not out robbing.”

Despite indisputable evidence that the current opiate treatment of heroin is not working, the
government is burying its head in the sand. The latest Health Research Board (HRB) figures
show an alarming increase in the number of methadone-related deaths. The figures show that
methadone was implicated in 113 deaths in 2011 rising from 60 deaths in 2010. This is a
staggering increase of 88% in methadone related deaths in just one year.

Deaths arising from more than one drug (polydrug use) also rose by 28% from 168 in 2010
to 215 in 2011. Due to the difficult nature in establishing an exact cause of death, toxicology
reports can take up to 18 months and this is why we are only seeing the 2011 figures now.
However nothing has changed since and the problem is only getting worse.

Methadone is used worldwide to help people come off heroin. When properly controlled and
administered and used in conjunction with other treatments, it has a vital role to play. In
Ireland there are a range of drugs known as benzodiazepines which include tablets such as
Diazepam, Zimophane and Stilnoct that are being prescribed by doctors along with
methadone to treat heroin addiction. The problem is that taking these drugs in isolation only
pacifies or compounds the problem. These drugs need to be administered in a planned and
very controlled way in conjunction with counselling and other resources in order to get
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people off drugs. In Ireland there is not enough of the other resources in order for opiate
substitution to be effective.

According to Anna Quigley of the County Wide Drugs Crisis Campaign, the government
know what needs to be done but it is the lack of political will that is stopping them. On the
ground, Anna and her colleagues are not getting the funding they need in order to save lives.

Maureen O’ Sullivan, Independent TD for Dublin Central, has been involved with helping
those with addiction for many years and is acutely aware of the magnitude of the problem.
The Government are clearly not prioritising the issue. "You can take the cynical attitude and
say right, the government will put the money into methadone because it keeps people stable
and they’re not out robbing.” What Maureen is seeing on the ground is an increasingly
dangerous level of polydrug use. “What we’re seeing around here now is people on
methadone are into alcohol and tablets and that’s a lethal mix.” Deputy O’ Sullivan also
believes that the Government have to look at the methadone protocol, in other words the way
in which the drug is administered. “There should be limits, you’re on so many mils for a
certain amount of time and then it is automatically reduced.”

Methadone and tablets are being prescribed to addicts in an alarmingly uncontrolled manner
with no discernable plan or aftercare. The widespread prescription of these drugs is creating a
black market for tablets on the main streets of the capital. Speaking to Mel MacGiobuin of
the North Inner City Drugs Task Force he told me that one of the problems is that “many of
these drugs do not have an illegal status even though they are being traded illegally.” Some of
these tablets are also used as muscle relaxants, sleeping tablets and antidepressants. If anyone
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has taken a walk down O’ Connell St or Abbey St recently this problem is very clear to see.
Tablets are being sold and traded openly on the streets.

Another huge problem is that even when people are on methadone and genuinely want to
come off it and detox, there is nowhere for them to go. According to Tony Geoghegan of
Merchants Quay Ireland, “the last prevalent study of opiate use in Ireland is back in 2008 and
it estimated about 20,000 heroin, opiate users in the country.”

At present there are just under 10,000 people on the Methadone programme with 7,000 of
these coming from the greater Dublin area. According to the HSE figures in November 2013,
there were eight detox beds in Beaumont Hospital. 12 to 13 beds in Cuan Dara, six beds for
the Dublin Northern area and nine beds in Keltoi which was to increase to 14 in January
2014. These are extremely alarming figures. There are approximately 40 detox beds for a
conservative estimate of 20,000 heroin users, 10,000 of whom are availing of a methadone
programme. According to the European Monitoring Centre for Drugs and Drug Addiction
(EMCDDA), approximately seven in every one thousand people in Ireland are using opiates
which is well above the European average.

If an individual is on a methadone programme and wants to avail of a detox bed, they are put
on a long waiting list. This only compounds the problem further as it is encouraging long
term methadone use. Deputy O’Sullivan concedes that, “People recognise that drugs are not
really on the agenda with the Government.” But that the fight for more detox beds is vital, “if
somebody wants to come off, they want to do it now while the motivation is high, not be told
there is a three month waiting list or a nine month waiting list.” Unfortunately even if an
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addict gets a detox bed and gets clean, the majority have to go back to deprived communities
that the government has long since forgotten about.

One ex-user gave me his view on the problem. “The resources are there as for every walk of
life for people with money, everything is there to get someone from the right side of the
tracks of it. Unfortunately, 90% of people who are on it come from the wrong side of the
tracks and don’t have money and come from broken homes, come from no work, come from
social welfare lives. They don’t vote, they have no say!” He told me that he believes that
everything has a domino effect and that the deeper routed societal problems need to be sorted
out before anything can change but that the tablets are the immediate problem.

“It’s worse because of the freely prescribed tablets to people by their doctors, doctors of the
state[…]These people have no money. There been prescribed these tablets just to keep them
out of it, to pacify them that they won’t be out robbing.”

He also told me that doctors were prescribing dangerously high quantities of methadone to
users and that they would keep on upping the dose until an individual gave a urine sample
that was clean of heroin. “I’ve heard of people being on 150ml a day, that’s a crazy amount.”
Often they’re not taking all of this methadone themselves. “Then there is the side of wanting
loads, so they can sell it because there’s the black-market value of it.” Shockingly he also
informed me that methadone was far more addictive than heroin and that at these high levels
if you stopped taking it, it could kill you. “Miss a day, they’d be very sick. They miss two
days, it possibly could kill them. Its lethal dangerous stuff.”

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While attending a City Wide Drugs Crisis campaign meeting in the Gresham Hotel it became
obvious that the increasing number of drug-related deaths was not a priority for either of the
two main parties. The fact that there were no representatives from either Fianna Fail or Fine
Gael at this meeting speaks volumes’. Speaking at the meeting Aengus O’ Snoaidh TD of
Sinn Fein said, “there needs to be properly funded drug task forces” and that if Sinn Fein
were in power there would be a separate minister for drugs.

The only representative of the government, Deputy Richard Dowds of the Labour Party
expressed his concerns. “I am not happy at all at this time with the spending, because I realise
fully that a great deal more is required.” One of the main positives that came out of this
meeting was people’s support for, and belief in CEs (Community Employment schemes).
These schemes, 1,000 of which are ring-fenced for recovering addicts provide training and
employment to long term unemployed and disadvantaged people trying to get back to work.

Two ex-heroin addicts that spoke at this meeting said that the specialised CE scheme had
saved their lives. Not surprisingly funding to this scheme was slashed in the 2012 budget.
People Before Profit TD Richard Boyd Barrett also addressed the meeting, “Cuts to CE
projects specifically CE projects related to drug rehabilitation are absolutely outrageous and
disgraceful, so we need to campaign against those cuts and have them reversed[…]this is part
of breaking an obnoxious attitude which I think is most pervasive in parties like Fine Gael
who essentially think that CE schemes are just a waste of money and time.”

The government is ignoring the heroin problem and the opiate substitution treatment of it.
The majority of people taking heroin are from a section of society that the government would
rather just pacify and forget about. They are not perceived in a way that warrants proper help,
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they don’t command the same attention as wealthier sections of society. In 2010 when
youngsters from all walks of life began having problems with legal drugs purchased from
“Head Shops”, the government acted quickly to close these shops and make the sale of novel
psychoactive substances a criminal offence.

Successive governments have ignored long term unemployment, generations of addiction
and housing problems in deprived areas because tackling these issues does not constitute any
political gain. These long-running attitudes have only served to compound the drug problem.
Too many people are dying and society as a whole needs to be aware of this and force the
government to take action. Despite several emails and phone calls to Minister James Reilly’s
office and Minister Alex White’s office, no one was prepared to discuss the issue.

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Image 1: Maureen O’ Sullivan Independent TD for Dublin Central

Image 2: Methadone Bottle

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I first decided to do this piece because I had heard that methadone was a very dangerous
drug and that it was in fact as dangerous as heroin. Firstly I began to look for figures and
statistics and discovered the Health Research Board figures that related to Ireland and
European statistics coming from the EMCDDA (European Monitoring Centre for Drugs and
Drug Addiction). Although I got some interesting information from the EMCDDA it was not
a compare and contrast exercise that I wanted to get into. Every country has their own drug
problems and while for example the decriminalisation of certain amounts of drugs has
worked to an extent in Portugal, it does not mean that it would necessarily work here. When I
delved a bit further and started to interview those who were involved and worked in the area,
it became apparent that they know and the government knows what needs to be done. This is
the most alarming thing that I tried to get across in the piece, the government knows what
needs to be done. There is just no political will to do it.

For this piece I Interviewed:
Maureen O’Sullivan: Independent TD for Dublin Central [email protected]
Ph: 087 9156435

Former Cllr Mel MacGiobuin: North Dublin Inner City Drugs Task Force
[email protected]

Former Cllr Anna Quigley: CityWide Drugs Crisis Campaign – I interviewed Anna when I
attended the CityWide drugs meeting in the Gresham.

Tony Geoghegan: Merchants Quay Ireland [email protected]

A former heroin addict who wishes to remain anonymous.

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I recorded all my interviews and then listened back to them to write the piece. I also recorded
Deputies Aengus O’ Snoaidh, Robert Dowds and Richard Boyd Barrett when they spoke
publicly at the CityWide Drugs Crisis Campaign meeting in the Gresham. I also tried to get a
representative from the DTCB (Drug Treatment Centre Board) and from the Rutland centre
but to no avail. As I stated in the piece I could not get anybody in the government to talk to
me on this subject. In hindsight I see that this problem is just part of a deeper rift in our
society but I am glad that I wrote this piece because it is helping me to see the bigger picture
and I hope it will have the same effect on those who read it. It is a story that I am not
finished writing and intend to go back to in the future.

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