A “waiting list crisis” among heroin users seeking methadone in rural areas underlines the need for nurses to be allowed to prescribe the drug, a leading addiction expert has said.
Dr Peter Kelly, assistant professor in mental health nursing at Trinity College Dublin, described as “extremely frustrating” the ongoing resistance within the Department of Health to nurses prescribing methadone, despite 14 years of campaigning and widespread use of the practice across other EU states and the UK.
He is urging the newly appointed Minister of State for drugs, Hildegarde Naughton, to urgently review a decision by her predecessor Frank Feighan that there was “no objective need for the introduction of nurse prescribing of opiate substitution therapy (OST)”. Mr Feighan stated this in a letter to Dr Kelly last month.
The Oireachtas Justice Committee last month urged an “evaluation of the role that non-medical prescribers could play in treating opioid addiction in Ireland, by increasing access to OST”. Other advocates for nurse prescription of OST include the Irish College of General Practitioners (ICGP) and the drugs users’ group, Service Users Rights in Action (Suria).
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They say allowing nurses to prescribe OST would eliminate waiting times and, by allowing nurses and doctors to take more time with service users, provide a more “holistic and rehabilitative response”.
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Waiting times for OST outside Dublin can be as long as three months. Data from the Health Service Executive (HSE) shows that as of November 30th last a total of 11,062 people were receiving methadone maintenance, with 70 people waiting to be entered on to the central treatment list. Referral to the list is the first of three steps to accessing OST.
From referral to assessment, the average waiting time nationally is 4.9 days but this ranges from less than a day in the midwest region covering Clare, Limerick and parts of Tipperary to 12.7 days in the southeast area covering Carlow, Kilkenny, south Tipperary, Waterford and Wexford.
From assessment to accessing OST, the average waiting time nationally is 25.5 days. However, this ranges from four days at the National Drug Treatment Centre on Pearse Street in Dublin to 83 days in the midwest area.
According to the ICGP, 368 GPs are prescribing methadone to 4,096 patients. “Waiting lists continue to exist in areas outside Dublin, particularly in remote areas,” it says.
Dr Kelly said “nurses have been making representations about nurse prescribing of OST to the Department of Health since the initial legislation for nurse prescribing was introduced in 2008″.
“Since then, groups of specialist nurses have met the department in 2015 and again in 2019 and in spite of assurances otherwise, these meetings have come to nothing. This is extremely frustrating. There is a clear waiting list crisis in some parts of the country,” he said.
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Dr Des Crowley, the ICGP’s director on the substance misuse programme, said the college “would support this initiative as long as it has clear training and supervision components within its structures”.
“Nurse prescribing is a feature of other programmes and it is underutilised in Irish healthcare. Methadone is a controlled medication and would need enhanced levels of oversight. Nurse/non-medical prescribing is used in OST (Opioid Substitution Treatment) services in the UK and is particularly suited to the long-term management of OST patients,” he added.
Dr Richard Healy, a former heroin user and OST patient now working as human rights researcher with Suria, has met Department of Health officials on several occasions since 2015 advocating for nurse prescribing. “The clinics are massively overburdened,” he said.
While accessing treatment is relatively easy in urban areas, the clinics do not have time to “engage in a meaningful way” with service users, which he believes precludes the rehabilitation and reintegration of recovering drug users.
“We need meaningful, therapeutic relationships in clinics. Nurses would really help in providing that,” he added.
Neither the Department of Health nor the Irish Nurses and Midwives Organisation responded to requests for comment.
