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ACCORDING TO FIGURES from the Health Service Executive 10,316 people are officially listed as receiving methadone maintenance in 2018. Of this number 4,069 have been on the drug for ten years or more.
Methadone was perhaps the core policy response from the Irish State to heroin use amongst working class young people. Communities had placed enormous pressure on the State to do something throughout the 1980s and early 1990s.
The question today is how effective has that methadone strategy been and what is the legacy we are left with when so many people are on the drug for so long?
The purpose of methadone as I understand it was to provide a bridge or a gateway to help people stop using heroin and to help them lead lives to their fullest possible potential.
It seems that for many the bridge has become infinite with no end in sight other than continued methadone maintenance.
Before I was born the first treatment clinic was set up to respond to what was termed then as ‘the problem of illicit drug use’. It was several years or so before responsibility was passed to the Eastern Health Board resulting in the establishment of the Drug Treatment Centre Board.
Throughout the nineties there was an expansion of services across Dublin to respond to the rising need for methadone maintenance provision.
Twenty years ago this month the Opioid Treatment Protocol was introduced. But where are things now, especially from a service-user perspective?
‘Something is failing’
After years of working in the services and after many conversations in recent days with past and present users of clinics; there was one big question on my mind: Why, when patients ask for their dose to be reduced do doctors refuse?
There is also the question as to the changing form and nature of drug use in general from the days of the monolithic hold of heroin in body and public imagination to what is now called a ‘polydrug’ use society.
Something is failing and there seems to be some level of secrecy or impenetrability around clinics when it comes to the treatment of the person using that clinic.
One woman described the experience as:
“I have no rights, I feel controlled and have no say in my treatment plan, every-time I ask to come down on my Phy I am told ‘no you’re not ready. That doctor sees me once a week and has no idea how ready I am, nor does he seem to care.” (Many still refer to the drug as Phy – the original brand name was Physeptone).
When we unpack this we have an individual looking for involvement in their treatment plan but the service is self-perpetuating and becoming an end in itself.
Here are just some of the responses from my own friends who have experience of being on methadone programmes.
Methadone treatment is not supposed to give you a stone, it should support stability, rehabilitation and harm reduction and yet we are on doses that is way beyond that. That is not a failure on behalf of the person but on the delivery of the treatment.
They never listened to us, I couldn’t breathe with their judgement. The General Assistants looked and operated like prison guards.
No-one should have over-all power over the individual’s treatment.
A few years ago I was docked in my Phy because I was late for an appointment.
The doctor should listen to the patient and assess whether they have already been practicing harm reduction, and if they have, then supported by medical monitoring can determine the amount of methadone they should be on.
The woman had been street buying methadone for two years before starting on a methadone programme. She had successfully stabilised herself on 25mg of methadone and the clinic refused to listen to her and insisted she be put on 40mgs.
She did not need to be on this amount and she felt her two years and getting to that point had been completely ruined. Throughout her time in the clinic she said that she was constantly offered increases in the amount due to her poly use of drugs.
Service providers
This frustration with the system is also felt at a service provision level. Communities who have been at the coalface of the heroin problem for years have always sought greater investment in services and in people. Community workers often champion a whole community approach to addressing substance misuse.
This has become almost impossible due to lack of investment and lack of acknowledgment of the inequality of conditions of the communities most affected.
The feeling on ground amongst many people involved in the running of Local Drugs Task Forces is that they are having less and less involvement in the decision-making process at a local level.
One community worker said that the HSE “is effectively involved in a power and resource grab and the democratic power-sharing approach that characterised the work of drugs task forces for many years is, the way things are going, increasingly a thing of the past to be replaced with a much more centralised authoritarian approach.
This is austerity’s second wave as it were. The new national drugs and alcohol strategy says ‘health led’. That doesn’t and shouldn’t mean total HSE domination and control.
The issues that arise at this macro level also arise for individuals as they enter a treatment centre. If we were really interested in removing the powerlessness of someone in addiction we would strive to include them in their treatment.
We must create a more equal relationship between the individual and the doctor, one that doesn’t reflect the dehumanisation they face in their daily lives.
Twenty years on from the Opioid Treatment Protocol and one thing is clear, we need to address the culture that has emerged in methadone treatment programmes. It is crucial we place the person at the centre of their own treatment.
We must also place the communities they come from at the centre of the strategy. There is a ‘community goal’ in the new national drug and alcohol strategy. It should be more than words on paper and really do what it says on the tin.
The community and voluntary sector that does most to support community responses to the drug problem was cut to pieces during the austerity years and there was nothing in the new national strategy to suggest that a proper funding restoration process would happen, as it is happening in almost all other sectors of Irish public life.
The restoration of funding to the community and voluntary sector must be accompanied by an acknowledgement that many of the successes of recent years were due to the autonomy and creativity of community led responses.
Let them get back to doing what they do best. Let me be clear in saying that I believe methadone has its place and is a form of harm reduction, however the big clinics and the culture that exists within them is not the way to deliver the programme.
We need to move to a more personalised approach to methadone that involves general practitioners and more integrated approaches at primary care level, with wider integration with the community projects, with a full removal of the punitive approach that is felt by service users in the clinics.
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jaysus , I thought you would need an alien invasion to get all these clowns fighting on the same side. Islamic State obviously haven’t read the book How to make friends and influence people
They prefer to read a book that advocates beheadings, massmurder and other kinds of brutality.
if they would ready any other books than koran they would never behave in such manner
*read
I don’t know about that – There are certain students of a book that says “Thou shalt not kill!” and they’re flat out doing the opposite … or another crowd that’s “well-in” as they say, and they not getting arrested for crimes against children …so you’re a biteen ignorant in the ways of the wprld I’d say Marcin !
Would be worse if nobody decided to stop the onslaught of ISIS.
Great to see a bit of co-operation in the middle east.
Iraqis are training on F-16 fighters the past few years.. Maybe the training was accelerated the past few months.. As far as I’m aware the Iraqi F-16 in “in country” awaiting pilots.. Good to see action been taken though, no matter who’s flying the attack aircraft
Excellent news. It’s in every right thinking person’s interest to stop the spread of radical Islam.
Here’s to a future of co-operation against ISIS and their ilk.
America, Russia and Iran on the same side! You don’t see that very often!
Maybe in a chelsea or arsenal team ?
It may be convenient for now, while the world is watching, for the US, Russia or Iran to fall behind the Kurds. In the same way as it was once convenient to Gaza-ise the Kurdish population and deliver best wishes with long range artillery and aerial strikes.
The global illiteracy of western populations is staggering.
“A ceaseless, nearly invisible war criss-crossing the borders between Turkey, Iran and Kurdish-controlled areas of northern Iraq has left thousands of impoverished Kurdish farmers resigned to their grim fate.
“Our lives are worthless because today we build up our house, tomorrow it will be destroyed by shelling – that’s our life,” said farmer Ahmed Abdullah. “Now, every day we wish for death.”
The undeclared war, pitting Turkish and Iranian armed forces against Kurdish separatist fighters based in Iraq’s autonomous Kurdish region, has been waged for years with tacit approval from the U.S., which supplies the Turkish military with intelligence on the guerrillas. And when the Turkish military plans an artillery barrage in the area, officers give American troops advance notice, according to U.S. soldiers working in the region.”
What’s wrong ? I thought Putin was a baddy and the sanctions and everything and now his pilots are fighting with America – something awful fishy going on in the Ukraine !
Plenty of Russians after the collapse of the Soviet Union went elsewhere to sell their military expertise to anyone who would pay for it. They’ve found themselves across the globe training and fighting in Second World and Third World armed forces.
Their presence there has likely nothing to do with the Russian government.
Are these pilots not contractors for the plane manufacturer?
They probably aren’t ‘soldiers of fortune’….
More just company employees making sure their product works.
Either way, any bomb dropped on these ISIS animals is welcome.
So it’s like Irish nurses then ..we spend a fortune training them and they go to London and the Oil-rich countries for work …ah I get it !
Jason Russia has personnel in Baghdad that assembled these aircraft. It’s not beyond the realms of possibility that they have authorised some pilots to fly missions against ISIS. Afterall Russia has a stake in this as well. A large contingent of Chechens and other Russians are part of the ISIS rank and file.
Polite term is “Mercenaries”.Nothing wrong with it either.Us Irish have been exellent guns for hire for centuries.Once you take the Irish out of Ireland and give them good leadership they are some of the most fiercest fighters on the planet.Pity we cant win any wars for ourselves.
“Pity we cant win any wars for ourselves.”
Arguably we fought the British to a stalemate and absorbed both the Vikings and Normans rather than being conquered by them. It also took the British centuries to bring Ireland under their full control and even then it was tenuous at best. We’ve had a pretty good military history for a small island surrounded by aggressive empires.
“Jason Russia has personnel in Baghdad that assembled these aircraft.`
Aircraft technicians and pilots are not the same thing. The personnel from Sukhoi who are assembling the aircraft are likely engineers and not pilots. There are a few pilots there to train and you are right in saying they may have clearance but it´s more than likely Iranian Air Force aircraft.
Arguably we fought the British to a stalemate and absorbed both the Vikings and Normans rather than being conquered by them. It also took the British centuries to bring Ireland under their full control and even then it was tenuous at best. We’ve had a pretty good military history for a small island surrounded by aggressive empires.
Where did we fight the British to a stalemate?Please dont say the war of independance or NI.
You know yourself that war of Independance could have been a lost situation if Lloyd George has “surged” the British army into Ireland.And NI was a police action with military assistance.Not a set piece battle.
The only utterly successful Irish action against the English,not the British as they wouldnt be around for another 200 years was at the Yellow Ford in 1566.The Vikings,how soon did they return to their cities post Clontarf?Nor did they have any intent to conquer the hinterland of Ireland unlike the Normans,who did actually conquer Ireland ,as we were too busy kicking in each others heads in as usual to fight off the invasion by stealth and sword.Under teneous control by the British??We signed away our parliment in Dublin for direct rule from London,got the crap kicked out of us in 1791,the battle of Kinsale,where all our elite[The Earls]like our modern politicans buggered off to Europe post haste when things got sticky.Aughrim,the Boyne,the two sieges of Limerick and countless other little badly planned uprisings .Actually Irelands military history is a litany of lost battles on Irish soil for Irish somthing or the other..
Yet in Europe,we have the Wild geese,Fontenroy,Marshall Hennessy,Mac Donald and a couple of others who were some of Napeleons best generals,Irish brigades the length and breath of European and American battles,even South America where a Mayo man founded the Argentine navy.
yhe Irish or men of Irish ancestory have won more times than any other nationality the American Congressional Medal of Honour,of that figure over 60% of them were from, or had ancestors from Limerick.
So yeah we win wars for everyone else but ourselves.But we are a race that God made mad..All or battles are happy and all our songs are sad.
Battle of Kinsale was 1601.
Yellow Ford was 1598 too. Jason’s point was that neither the Vikings, Normans nor the British were able to defeat the Irish. We won plenty of battles too, during the 1640′s, 1690′s and 1790′s.
Thanks for the date corrections..
Ok which battles did we win that beat the English in set piece battles on Irish soil that decisively changed Irish history to make the English pack up or grant us some sort of freedom to be a nation?
As I musta skipped those clases in Irish history,or more like our history teachers didnt consider these great victories over the eternal foe worth mentioning?
While we would like to think the Vikings were defeated by the Irish as were the Normans,history actually tells a different tale,as said before the Vikings had no intrest in conquering Ireland anyway.They used it as a raiding base and trading post.Post Brian Boru,Ireland went back to doing what it was best at ,tribal warfare.Main reason a minor king invited the Normans into the place .If you want to claim an Irish victory over the Normans,it would be better to say they were asslimiated into Irish society,but that the Irish militarily defeated the Normans or the English….This I want to read.
The point was, we couldn’t be defeated.
The british were kicked out in the 1920s …hence the independent sovereign State, although your post suggests you think that the british haven’t been defeated in Ireland yet ..that involves some extra work for the Irish I’d say … A little bit of “rooting out” – we’d call it…best way to kill a weed;- kill the root !
Th point is you havent answerd the question about where the Irish defeated the English in a set piece battle as you claimed in the dates mentioned..So when or where did this happen as you assured us it did?
Hmm.I seem to remember that they withdrew in an orderly fashion and not in a panicked rout which is what a kicking out would suggest.Apart from three ports that is and six counties up in the North,and then the Irish reverted to the good old way of kicking the crap out of each other to see who is in charge and almost brought the British back in again….Looks like General Giap was right about the Irish struggle.. ” They have fought for 800 years to free their nation…They are not fighting they are playing at war.”Coming from a country that had various invaders in 1000 years it is saying somthing and managed to get rid of two Western powers in ten thousand days even moreso.So when are you going to do some gardening Dermot Ryan maybe in another 300 years tIreland might get six counties back,but you are too dumb to realise your fight isnt with West minister anymore ,its Brussels thats the new oppressor.
The West Cork Brigade crushed the British at Crossbarry and Kilmichael in 1920/21 – actions which had a major influence in changing the course of Irish history.
Won’t are you accusing me of being a Europhile ?…that’s the funniest thing I have read !
Look at it this way won’t … the roman empire may have lost it’s military control but it still maintained its indoctrination through the R.C.C. . the queen’s visit last year was not for the Irish in Ireland – it was aP.R. exercise for the Irish in England !
When Irealnd defeated the British army and it returned home having lost the colony the systems british had used for centuries- education , religion and civil service were not dismantled and that is phase 2 ..when that is achieved then there will be no border !
There are reports that retired Syrian AF pilots are flying them as well. Goes to show how messed up the ME is.
Iran or Syria’s contribution in eradicating these western armed and trained cockroaches would certainly be welcome.
Western armed, but I don’t think western trained. Chopping off limbs and burying people alive is hardly Western.
No – blowing up folks with depleted Uranium shells and white phosphorous is more in line with western tastes
Actually they are western trained, Iraq veterans have studied dozens of their propaganda videos and the verdict was unanimous, trained to American combat techniques and standards, their book however, is not the Quran, it’s the Ghenghis Khan terror manual.
And just a bit of good news.
An Isis commander at a terrorist training camp north of Baghdad accidentally detonated a belt packed with explosives during a demonstration in front of a group militants on Monday, killing himself and 21 nearby trainees.
Reported last words were” Pay attention now!! I’m only going to demonstrate this once for you!”
Ah the kids, they blow up so fast nowadays…
Only a few years ago the Kurds were the Palestinians of the middle east. Today, thanks to (fleeting attention) CNN and Sky news they are the good guys.
How long before the world turns its back when the next Netanyahu opens up on the Kurds?
Time to smell the coffee people.
“A ceaseless, nearly invisible war criss-crossing the borders between Turkey, Iran and Kurdish-controlled areas of northern Iraq has left thousands of impoverished Kurdish farmers resigned to their grim fate.
“Our lives are worthless because today we build up our house, tomorrow it will be destroyed by shelling – that’s our life,” said farmer Ahmed Abdullah. “Now, every day we wish for death.”
The undeclared war, pitting Turkish and Iranian armed forces against Kurdish separatist fighters based in Iraq’s autonomous Kurdish region, has been waged for years with tacit approval from the U.S., which supplies the Turkish military with intelligence on the guerrillas. And when the Turkish military plans an artillery barrage in the area, officers give American troops advance notice, according to U.S. soldiers working in the region.”
What do you want to be when you blow up son?
Patriotism today is the cruel tradition of an outlived period, which exists not merely by its inertia, but because the governments and ruling classes, aware that not their power only, but their very existence, depends upon it, persistently excite and maintain it among the people, both by cunning and violence.
Patriotism today is like a scaffolding which was needful once to raise the walls of the building, but which, though it presents the only obstacle to the house being inhabited, is none the less retained, because its existence is of profit to certain persons.
Leo Tolstoy
False flag !!! Numbers !!!! Jewish conspiracy !!!
Hi Frank
SU 25 56 + SU 25 56 = U.S 33 (BACKWARDS )
The maths … 5-2 = 3 x 5+6 = 3×11 = 33 twice and divided by 2SU = 33 backwards = 33 !
Proving what exactly Dermot ?That you can have fun with numbers??
proving that numbers are nothing more than what you make them out to be ..it’s a journal joke – welcome aboard !
From what I heard, up until Saturday, they’d only dropped two bombs, I’d say they’re very hesitant to really go after they’re proxy army of ret@rded rodents.
That’s certainly true.. MOSSAD / CIA are not going to go to the trouble of building a regime changing terror group and then have them destroyed.
The footage you see of US Bombing ISIS would be course be faked.
There is plenty of work to be done in Syria.
http://www.presstv.ir/detail/2014/07/26/372806/isil-terrorists-kill-50-syrian-troops/
If Russia and Iran are getting involved against ISIS(Al Qaeda) it is because the US is not attempting to stop them. They’re just trying to put a nice humanitarian face on the psychos they created and armed while bombing minor targets. Russia and Iran would not want the Kurdish population in Iraq massacred. That’s why they stepped in. The US and Russia are NOT fighting side by side
Bang on.
You really believe that? Weird
Too many US bashers on here Stephen. They are at it all the time and any excuse.
And if there’s no excuse they’ll invent one.
Paul if you’re not a US basher at this point then you will believe almost anything. Go wave a flag
Its not they US bashing that’s the problem Niall – they deserve a lot of criticism – but the selective US bashing. The hypocrisy of the headlong rush to find a way to bash the US whilst ignoring or supporting similar or worse actions committed by others.
I recently heard probably the best way to describe the US and it’s foreign policy, “a schizophrenic giant”. On the one hand the country is an amazing superpower and it’s founding principles of liberty are admirable but when it comes to taking care of its own national interest abroad it has to resort to being a bit of a bully in total contrast to its founding principles.
This is not “US bashing” but logical thinking. Whom else we are to thank for destabilizing Iraq and Syria making ISIS a possibility? So far we have three countries destabilized by the US to a different degree that can and most probably will be breeding grounds for militant Islam – Iraq, Egypt and Syria. Libya is further away, but same pattern was applied there – the existing stable regime overthrown by US intervention opening doors to chaos.
Saddam Hussein’s antics destabilized Iraq, Likewise for Gaddafi and Morsi. Right now Malaki is not helping Iraq’s stability.
I just wrote a big reply and the Journal wont post it no matter how many times i send it.
If the reply was civil and not rude the it shouldn’t be a problem to post Keep trying.
I kept trying Stephen. It wasn’t rude or anything it just wouldn’t post. It happens all the time
Its founding principles were built on the extermination of the Native American and enslavement of Africans, the amount of american ass kissing that goes on in this country is sad but unfortunately we have always had our few gombeens.
You know they have had a cure for Ebola for quite awhile right? Its just another weapon in the arsenal against africa.
Elduderino, you do realise that virtually every so-called ‘civilization’ since the dawn of humanity has been based on murder and pillage? The US certainly aren’t alone in that. Tribal and religious differences remain at the heart of much of the ongoing violence in the middle east today, albeit that it took the US to uncork the bottle that was held firmly closed by tyrants like Saddam and Gadaffi.
When did Al Qaida become Isis – that’s News !
I bet it is news for you.
Avina – Yes thats true but I can only think of one atrocity so bad in the last 500 years.
The tribal and religious differences are due to how the Ottoman empire was divided up by Britain and the US. Gadaffi and Sadam would not have been there in the first place if it weren’t for the US.
I’m not looking to bash the states, maybe its just because they have been the ruling power in the world the last while but all of these problems lead back to their door.
I do think people identify themselves too much with America here, Head down around south side Dublin and half the kids sound like they are over on holidays from the California Valleys. if people want to think and act like they are American they are free to but I don’t have to like it.
Don’t be so naive elduderino – how do you think the Ottoman empire was created in the first place?
To complete the picture we possibly have Assad, Iran, Iraq, Russia, Turkey and US all on the offensive against the “Islamic State” all is need now is for Israel and Gaza to join the party. ISIS might succeed where others have failed and unite Islam, Christian and Jew against them. Some achievement!!!!!!
have your say