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On the basis of urinalysis results, presenting health and behavioural problems and more general day-to-day observations, many professionals, working in the greater
Dublin area with heroin addicts maintained on methadone, are reporting significantly
increased use of cocaine among their clients over the past year. The aim of the
research was to assess the problems and needs of these clients, associated with
cocaine use, in relation to the capability of existing facilities and infrastructure to
effectively address them. One-on-one semi-structured interviews were conducted with
15 clients, accessed through six Local Task Force Projects in the greater Dublin area,
using cocaine to various degrees supplementary to methadone-maintenance treatment.
While methadone treatment had significantly reduced dependence on heroin, the
respondents reported a seriously high level of dependence on cocaine, alcohol and
benzodiazepines. A high level of comorbidity of substance use disorders and mental
disorders was indicated. Overall, the results suggest that the relative success of
methadone in containing the heroin problem of such clients masks significantly
insufficient treatment of other biological and of psychological and social factors
driving excessive use of cocaine, alcohol and other drugs. A directly related
considerable risk is indicated in relation to the potential for Irish society to experience
a cocaine epidemic of crisis proportions. Delivery of the far more comprehensive
treatment required is limited by existing funding, facilities and the lack of provision of
truly integrated treatment teams with appropriate competencies on the ground. A
number of recommendations to address the serious shortcomings and risks indicated
by the findings are presented.
