Out on a limb — heroin users beyond the pale

Professor Michael Farrell’s recent review of the methadone treatment protocol (The Introduction of the Opioid Treatment Protocol, HSE, December 20, 2010) came at a crucial time in the development of drug treatment services in Ireland. Born in Galway, Michael Farrell is recognised internationally as an expert in the field of addiction. He has worked as Professor of Addiction Psychiatry at King’s College London and Director of Postgraduate Medical Education, South London and Maudsley Trust and has published extensively on the topic. The situation regarding access to drug treatment in Ireland today is very serious. Services in the greater Dublin area, on the whole, are coping with demand, having been developed in times of plenty. In most other areas of the country, however, the story is very different, with one prominent drug treatment expert describing the situation regarding heroin use and resulting personal and public health and criminal justice problems outside the capital as “spiralling out of control”. We are now entering a period in this country very similar to the 1980s with a severe economic downturn, mass unemployment (especially among the youth), emigration and an untreated heroin epidemic in large parts of the country. Lessons need to be learned from that era