Exclusive: Major Crisis Looming in Dublin Addiction Centres

A policy of closing addiction clinics in Dublin may be being put into effect by the HSE.

While confirmation of this new direction for the treatment of drug addiction has not yet been provided by the HSE, Hot Press has been told by workers that the policy is already being actively pursued by the health authorities, and that the closure of at least some clinics is inevitable unless there is a dramatic change of thinking at the highest level.

The move, which is greatly upsetting workers in addiction clinics, would seem to be in line with the wider push towards directing patients in Ireland into what is called ‘primary care’ – that is, to drive them away from the hospital system and into a situation where their health needs are managed by GPs.

That may well be a laudable objective for ordinary patients. However, there is considerable concern among those who deal with addiction on a daily basis that GPs simply do not have the experience, the resources or the systems required to manage the welfare of addicts properly. Hot Press has been warned that the effect is likely to be catastrophic for those who are addicted to heroin, and who are currently on a methadone programme.

“Doctors with no knowledge of addiction, and no means to check patient's recent drug use, would be in charge of their health care,” one well-placed source told us. “It makes no sense whatsoever, but that is the way things are moving.”

One of the key functions of addiction clinics is the daily administration of methadone to patients, as a heroin replacement. While there are valid questions to be asked about the methadone programme, simply shunting responsibility for it to general practice doctors is not an appropriate response.

“That kind of micro-management of the distribution of methadone is absolutely essential,” another addiction expert told Hot Press. “The fact is that methadone is now being sold on the streets of Dublin. It has become currency. And that abuse of the system, with addicts selling the drugs given to them for their own use, will increase hugely if the care of addicts is passed over to already over-stretched doctors."

GPs tend to prescribe addicts with a week’s supply of methadone. “In fact ,we have seen prescriptions for up to a month’s supply,” another counsellor told us. While this might be a time-saving and therefore cost-cutting exercise in theory, it greatly increases the risk of patients self-administering larger quantities of the drug quickly and running out; and even more worryingly, it multiplies the likelihood of the drugs being traded on the streets.

Methadone is already widely sold on the black market, currently at an average price of €20 euros for 80ml.

“To imagine that addicts won’t sell the drug is to misunderstand the nature of addiction,” a counsellor said. “Obviously every individual is different. But the lure of heroin is desperately strong and the culture is deeply embedded. Patients benefit from the routine involved in daily contact. Everyone wants the people involved ultimately to fly on their own wings. But to think that you can dispense methadone on a weekly basis and not see a significant reversion to serious drug addiction is naive in the extreme."

Addicts who sell methadone are in a far better position to buy heroin or crack cocaine – which is also widely available now, in particular on the north side if Dublin. The effect of taking the management of addicts away from clinics will be that patients will be in possession of a highly addictive drug that is in demand on the market. One source described the move as being "like handing a baby a revolver."

The HSE has yet to respond to whether it is their policy to move patients from drug addiction clinics to primary care.