Topics
1. National context
On 1 January 2005, the 10 Health Boards managing the health services in Ireland were replaced by a single entity, the Health Service Executive (HSE), which manages Ireland’s public health sector. The management of all dependence services is under the remit of Primary, Community and Continuing Care who will oversee a number of national care groups.
Treatment is provided through a network of statutory and non-statutory agencies. There are two broad philosophies through which treatment services are provided, namely: medication free therapy and medically-assisted treatment. There is a small degree of overlap between the two. Medication-free therapy uses models such as therapeutic communities and the Minnesota Model, though some services have adapted these models to suit their particular clients’ needs. Pharmacologically-assisted treatment includes opiate detoxification and substitution therapies, alcohol and benzodiazepine detoxification, and psychiatric treatment. Various types of counselling are provided through both philosophies of treatment and independent of either type of treatment. The total number of drug treatment services available in Ireland showed a strong increase between 1998 and 2004 with the largest expansion in the outpatient sector.
Three inpatient units and a number of outpatient treatment centres provide detoxification for problem opiate users.
Methadone, introduced in 1992, is the most commonly-used drug for opiate detoxification, buprenorphine (since 2002), the buprenorphine/naloxone combination (since 2007) and lofexidine are also prescribed to detoxify opiate users. In Ireland, methadone is the opiate substitute of choice for maintenance therapy. Treatment centres, satellite clinics and General Practitioners provide substitution treatment and the number of methadone treatment places has increased drastically, from 2,859 in 1997 to 10,213 in 2008.
Funding for treatment is generally provided by the statutory sector through the Health Service Executive. However, in some cases individuals are obliged to contribute to the cost of drug treatment (excluding methadone therapy), usually through private medical care plans.
2. Treatment registries and monitoring systems
At present there are two national registers recording drug treatment in Ireland. The National Drug Treatment Reporting System (NDTRS) is an epidemiological database on treated problem drug use set up in 1990 and managed by staff at the Drug Misuse Research Division of the Health Research Board. This reporting system complies with the requirements of the Treatment Demand Indicator (TDI) protocol.
The Central Treatment List is a complete register of all persons treated with methadone and is used to regulate methadone use and pay general practitioners for their services. The variables collected through this system are name, address, date of birth, place where treated, type of methadone treatment, date started this treatment episode, date exited last treatment episode and reason for exit. This list is administered by the Drug Treatment Centre Board on behalf of the Health Service Executive.
The number of treatment places for opiate dependence increased from 6,000 places by end 2001 to 7,390 places by end March 2005. Each treatment centre and general practitioner have a maximum quota of clients that they are allowed to register. The quota depends on the services provided as well as staff qualifications and mix. The number in each quota are referred to as treatment places.
3. Treatment demand
| Clients in treatment | 2005 | 2007 | 2008 |
|---|---|---|---|
| Number of all clients entering treatment | 4671 | 5775 | 6387 |
| % of which for opioid use | 61.6 | 63.9 | 64.2 |
| % of which for cocaine use | 10.0 | 13.3 | 11.7 |
| % of which for cannabis use | 22.4 | 16.3 | 18.3 |
| % of which for stimulants use (other than cocaine) | 3.5 | 3.5 | 1.6 |
| Number of new clients entering treatment | 2007 | 2475 | 2774 |
| % of which for opioid use | 36.6 | 43.4 | 45.1 |
| % of which for cocaine use | 13.9 | 19.0 | 16.5 |
| % of which for cannabis use | 40.2 | 28.1 | 30.8 |
| % of which for stimulants use (other than cocaine) | 5.7 | 5.4 | 1.0 |
| Notes: The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin. The data for 2001–05 exclude clients treated at general practices as the data collection had not been completed at the time of data submission. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009 and TDI tables (ST34) V. 1.0-2007, questions 13.1.1 and 13.1.2. EMCDDA Statistical Bulletin 2005, 2007 (Tables TDI 4 and 5) and 2010 (Tables TDI 2 and 5). | |||
4. Treatment provision
| Type of treatment | Availability |
|---|---|
| Psychosocial out-patient interventions | Full |
| Psychosocial in-patient interventions | Extensive |
| Detoxification | Limited |
| Substitution/maintenance treatment | Extensive |
| Notes: For an explanation of terms used, see the definitions of terms. Based on question 3.1 " Please assess the current availability of the treatment interventions below in relation to the user needs, judging the degree to which treatment capacity matches the demand" of Structured Questionnaire SQ27P1 on 'Treatment programmes'. Rating Scale (level of availability):
Reitox national reports 2008, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| Opioid substitution treatment | 2005 | 2007 | 2008 |
|---|---|---|---|
| Number of clients in opioid substitution treatment | 9028 | 9302 | 10213 |
| of which with methadone | 8962 | 9302 | 10213 |
| of which with buprenorphine | N. Av. | 0 | 0 |
| Notes: For a detailed European overview please see Table HSR-3 in the EMCDDA Statistical Bulletin 2010. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |||
| Applied substances in opioid substitution treatment | Officially introduced in |
|---|---|
| Methadone (MMT) | 1992 |
| Buprenorphine (HDBT) | 2002 |
| Heroin assisted treatment | N.App. |
| Slow-release morphine | N.App. |
| Buprenorphine/naloxone combination | 2007 |
| Notes: For a detailed European overview please see Table HSR-1 in the EMCDDA Statistical Bulletin 2009. ‘N. App.’ stands for ‘Not applicable’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2008, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| Legal framework of opioid substitution treatment | Methadone | Buprenorphine |
|---|---|---|
| Do office-based medical doctors have the right to initiate the prescription of substitution treatment? | N.App. | N.App. |
| Do specialised medical doctors have the right to initiate the prescription of substitution treatment? | Yes | N.App. |
| Notes: For a detailed European overview please see Table HSR-2 in the EMCDDA Statistical Bulletin 2010. 'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors. Notes: For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | ||
Treatment availablity in Europe
The graphic below presents an overview of treatment provision by different types of service (psychosocial outpatient, substitution, psychosocial inpatient and detoxification) in different European countries and can be used for comparative purposes. Click on the thumbnail to view it.
Figure 1: Treatment availability in Europe, 2007
5. References and links
Related EMCDDA resources
- Health and social responses statistics
- Treatment demand statistics
- Annual report on the state of the drugs problem
- National reports for Ireland
- Country overview for Ireland
- Drug treatment responses page
- Best practice portal
- Treatment demand key indicator page
For a comprehensive overview on drug treatment systems, availability and utilisation in Europe, please consult the 2008 online report on ‘Quality of treatment services in Europe — drug treatment — situation and exchange of good practice’ published by the Directorate General for Health and Consumers.
External links
Please note that the EMCDDA is not responsible for the content of external sites.
- Institute for Public Health in Ireland (EN)
- National Advisory Committee on Drugs (EN, GA)
- Trinity College Dublin (EN)
- Drug Treatment Centre Board (DTCB) (EN)
- Health Research Board (EN)
- National Documentation Centre on Drug Use (EN)
- Merchant's Quay Ireland (EN)
- Research Outcome Study in Ireland (ROSIE) (EN)
- The Hanly Centre (EN)
- CityWide Drugs Crisis Campaign (EN)
Treatment inventories
