The implications of significantly increased use of cocaine by opiate-dependent individuals in methadone maintenance treatment

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McMahon, Gerry
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BA Counselling and Psychotherapy
Dublin Business School
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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.