Seanad Éireann - Volume 137 - 27 October, 1993

Adjournment Matters. - Needle Exchange and Drug Maintenance Clinic.

Mr. Doyle: I thank you, a Chathaoirligh, for allowing me to raise the need for the Minister for Health to ensure that the needle exchange and drug maintenance clinic at Baggot Street Hospital, Dublin 4 is carried out in such a way as to protect the residents of the area and their property from harassment, intimidation and general nuisance.

The AIDS Resource Centre at 19 Haddington Road was opened about four years ago to prevent the spread of AIDS [1620] among drug users. In August 1992 the Eastern Health Board established a clinic there to provide primary health care to those who might be HIV positive or were in danger of becoming HIV positive. Prior to September 1992 about 60 people were receiving methadone treatment at the clinic but by October 1992 the number had increased to 160 and by Christmas the number was 200. The increase in numbers has caused problems in the area.

I will describe the kind of area Baggot Street is. It is a closely knit residential and commercial community. The residential community is mostly comprised of elderly people and a number of senior citizens. I propose to share my time with Senator Manning as he is a resident in the area and lives a short distance from the clinic about which I am speaking. He will outline the difficulties residents have experienced. I wish to explain the difficulties the business community have experienced in the area.

Businesses on Baggot Street include the usual commercial businesses such as banks and shops but there are also a number of service shops such as restaurants, cafes, dry-cleaners and so on. Since the numbers increased at the clinic, they have suffered severe harassment. Going around the area last week I discovered that a number of cafes and restaurants have to employ security personnel between 10 a.m. and 4 p.m.

The clinic has enticed many undesirables into the area including people who might not need or be dependent on methadone treatment. I have been informed by the gardaí that a number of drug pushers have been found in the area and that is a serious cause of concern. The problem was not helped when the hospital authorities opened a door at the side of 19 Haddington Road. It is a small lane about the width of the Press Gallery in the Chamber and people receiving treatment have to go in that way.

I received a number of representations on this matter and I will read one from Dr. Walter Halley. I discussed this matter with him this afternoon and he has given [1621] me permission to quote his representations. He said:

Many of my patients have been harassed and several of them in recent times have been mugged. They are all elderly, usually female. I would also like you to note that I have been personally threatened and have many problems with some of these people arriving in my surgery and on several occasions I have difficulty getting them out.

He went on to refer to the problems that the shopkeepers are experiencing and then mentioned the needle exchange:

I have on several occasions recently regarded with great caution deposited needles and syringes with physeptone bottles, some of them half full. Surely this is totally unacceptable in an area which is beside a large junior school.

They are the problems residents in the area are experiencing. I became aware of them in February when the numbers increased to 200. I attended a number of meetings organised by the residents and the business people. At my invitation the chief executive officer of the health board attended two of these meetings to see what could be done to resolve the problem.

I am disappointed that the Minister for Health is not in the House — I do not mean any disrespect to the Minister of State. I met the Minister for Health privately about this problem. I met him at the annual health board meeting in Bundoran last April and undertook to give him details of the problems, which I did one week later. It saddens me that I only received an acknowledgement from the Minister; he never replied to my representations.

In my representations I stated that residents of the area — Dr. Halley also states this — are prepared to accept that people from the catchment area be treated in this clinic. If the situation is allowed to continue the goodwill of the people will be lost. Time is running out on us and something must be done.

[1622] I suggest to the Minister that only people from the catchment area be treated there. Dr. Joe Barry, the AIDS and drug co-ordinator for the Eastern Health Board who is in charge of the clinic, told me that 30 people are being treated at that clinic from that catchment area. I am referring to health area No. 2 in the Eastern Health Board region which is divided into ten. I support any treatment programme to help people break their drug habit. I will conclude by quoting the following from what Dr. Barry stated in a letter to me, dated 20 October, 1993:

However, the situation is always volatile and we are continuing to monitor the situation. We have a security man on duty from 9 a.m. to 2 p.m. every day to patrol the lane through which patients gain access to the hospital. We also have a 24 hour video recorder in the lane so any disturbance can be recorded.

I ask the Minister to reduce the number of patients being treated to 30 and to treat them with a certain dignity by allowing them to enter the hospital through 19 Baggot Street and not through the laneway where there is a video camera and security patrol. It is not right that they should have to go through a laneway to receive this treatment.

Mr. Manning: I thank Senator Doyle for raising this issue and sharing his time with me. He has made his case strongly and fairly. The people in this area are not against the clinic. They realise that those attending the clinic have a problem for which they must receive treatment. However, they are saying that the numbers must be controlled to prevent the nuisance, harassment and intimidation which has been there for some time.

Senator Doyle described the area well. It is a settled and good business area and is one of the oldest parts of Dublin. It is a tolerant area but it is also vulnerable for three reasons. First, as Senator Doyle said, many old people live in rent-controlled flats in the area. Many of them have, as Dr. Halley outlined, been the [1623] victims of mugging, threatening behaviour and intimidation.

Secondly, the area is vulnerable because there are so many young people. The centre in question is close to a number of national and secondary schools. On many occasions children have been intimidated by some of those receiving treatment in the clinic. Thirdly, it is vulnerable due to the range of businesses there. They are thriving service businesses, such as pubs, dry cleaning, mini shops and so forth, and every business person has, not once but on several occasions, been threatened with syringes or abusive behaviour. As a result some pubs do not open until late in the day.

Dr. Halley, who is a respected doctor in the area, outlined the situation in a fair way. He could have said that people have been attacked in the church and that they are now afraid to go into the church out of fear of attack. It is also a frightening experience for a young assistant in a shop or a pub to have somebody wave a syringe at them and threaten to inject them with an AIDS infected syringe. Likewise, the people lurking in laneways have intimidated people.

Senator Doyle has made the essential point, the people in this area are tolerant, good and decent. They realise there is a problem. They are willing to accept that people in their catchment area must be treated and treated with dignity. They are not prepared to accept that their hospital be used as a dumping ground for people from across the city who need treatment. Dumping large numbers of such people in the area leads to the problems of security I have described. When that happens the good will of the people in the area is forfeited. Senator Doyle said it may be forfeited. People have had to put up with a great deal and have done so patiently and quietly.

I ask the Minister to resolve the problem in such a way that those in the catchment area can continue their treatment with dignity, under supervision and in such a way that people of the area will not have to live under threat.

[1624] Minister of State at the Department of Health (Mr. O'Dea): The Eastern Health Board established two clinics in August 1992 in response to the recommendations of the Government Strategy to Prevent Drugs Misuse and of the National AIDS Strategy Committee. These clinics, which are not directly associated with large hospitals, are known as satellite clinics.

Central to the Government's policies on drug abuse and HIV/AIDS is the unfortunate fact that of the people in this country who have developed full blown AIDS, intravenous drug abusers account for 44 per cent. The figures for HIV infection are even more revealing: 58 per cent of all those who are HIV positive are drug abuse related.

In such circumstances, therefore, both the Government Strategy to Prevent Drug Misuse and the National AIDS Strategy Committee recognised that the treatment of such individuals and the need to target prevention strategies to at least reduce and at best halt the spread of infection are of paramount importance. The Eastern Health Board chose Baggot Street community hospital as one of the locations for a satellite clinic because of its central location, its catchment area and because it had already been providing services through the AIDS resource centre for some considerable time. For these and other reasons it was regarded as a very suitable centre from which to offer services.

I am, of course, aware that there have been difficulties in the locality which have been blamed on the patients attending the Baggot Street clinic. Any incidents which have occurred are to be regretted but I know that the health board staff regularly liaise with the local gardaí, based in Donnybrook, and have employed a security guard specifically to ensure, as far as is practicable, that the clients attending at the clinic are of good behaviour. The board's officers have also met on a number of occasions with local traders and residents' associations and I am satisfied that everything possible is being done to ensure that the clinic operates with the minimum of interference to the local community.

[1625] Since the Baggot Street clinic began to provide services over one year ago it has been successful in providing treatment and services for a group of people for whom it is notoriously difficult to provide services. These services are being provided in tandem with, and complementary to, a methadone maintenance programme. For those who are not aware of methadone or its properties it is a heroin substitute which has a longer half life thereby lending itself to a once daily dose for addicts. It can be used in a variety of ways including as a stabilising element for drug abusers; as part of a detoxification programme or as part of a longer term maintenance programme.

The use of methadone in such circumstances to provide a dose of medication which is capable of maintaining a patient at a particular level is recognised internationally as a proven method for controlling the often chaotic behaviour of drug abusers. The Government Strategy to Prevent Drug Misuse and the National AIDS Strategy Committee recognise that the ultimate goal should be to help drug abusers to work towards a drug free lifestyle. However, in practical terms, in order to ensure that clients present for treatment and services it is necessary to offer methadone as part of the treatment regime. Patients can then be assessed for future treatment needs, their behaviour can be monitored and, if necessary, they can be referred elsewhere for treatment.

Central to this policy of providing methadone in such controlled circumstances is the necessity to monitor and evaluate its availability outside of such clinics. I am obviously supportive of the provision of methadone in the community where the proper guidelines have been followed and where there is close regular liaison between general practitioners providing such a maintenance programme and the statutory authorities. Otherwise there is obvious potential, which will be speedily exploited, for drug abusers to obtain excessive quantities of controlled drugs such as methadone.

In order to provide such guidelines I accepted earlier this year the recommendation [1626] concerning a Protocol on the prescribing of methadone which was drawn up by an expert group within the Department of Health. This Protocol gives clear guidelines for the essential requirements for providing methadone maintenance programmes in the community and introduces the concept of treatment cards and treatment lists. These innovations will mean that large concentrations of abusers at particular clinics will be avoided in the future and that general practitioners will have clear guidelines available to them to protect them from persons trying to abuse their services.

I am informed that the treatment list will be introduced shortly and that the other elements of the Protocol will follow in the near future.

In the Baggot Street clinic at Christmas 1992 nearly 200 persons attended daily for methadone maintenance. As a result of various initiatives, including the transfer of patients to the newly opened satellite clinic on the north side of Dublin, transfer of some patients to the Drug Treatment Centre, Trinity Court, and the opening of a clinic at the premises of the Drug Treatment Centre, Trinity Court, which is staffed by Eastern Health Board personnel, the number attending for daily methadone maintenance at Baggot Street is now less than 100.

In all the circumstances I believe that the Eastern Health Board staff are providing an efficient, caring, comprehensive service to persons who do not always appreciate such service but who must be helped because of their needs and also because of the threat that their chaotic behaviour can cause to the community at large.

To summarise, large concentrations of people in receipt of this treatment will be reduced when the protocol goes into operation. Secondly, by providing extra satellite clinics we are reducing the number which will be treated at any one clinic and we are going to proceed to do that as quickly as resources allow. That is not just an empty political promise and I hope to have a positive announcement on that between now and Christmas. [1627] Thirdly, in my capacity as Minister of State at the Department of Justice I will speak tomorrow to the Garda Superintendent in Donnybrook to see if we can intensify the liaison between the local gardaí and the clinic.

Senator Doyle raised a question about people having to go through the laneway. I have taken a note of what the Senator said and I will talk to the Eastern Health Board about that to see if we can alleviate that problem.

Mr. Doyle: Would the Minister of State agree that the acceptable number would be the number for each health board catchment area which would be 30 in the area we are talking about?

Mr. O'Dea: The problem with confining each area to the people from its [1628] own catchment area is that we would immediately have to provide a considerable number of extra satellite clinics — I do not have the exact number — one for each catchment area. We might not be able to do that as the numbers living in each catchment area would not be similar. Some catchment areas could have three or four times the population of others. If we were to reduce the number to 30 immediately it would be beyond our present resources. However, the fact that we are providing extra satellite clinics in conjunction with the implementation of the methadone programme will alleviate the situation considerably.

The Seanad adjourned at 8.55 p.m. until 10.30 a.m. on Thursday, 28 October 1993.