Sub. ID
Source if
individual Organisation Submission
1 Dr Garrett
McGovern Drug users in Garda custody. The treatment of drug users arrested by the Gardai is less than ideal. More often than not drug users are left without any treatment for the duration of their arrest. Gardai are slow to contact treatment providers. The training of Garda GPs in drug treatment is poor and needs to be improved.
2 Addiction
Services Dublin Mid-Leinster South Western Region
Clear protocol with Level 1 GP training a minimum. There should be a clear protocol in relation to the provision of methadone in the Criminal Justice System. Garda Doctors should be trained to at least Level 1 to ensure best practice in the provision of methadone to individuals in Garda Custody.
7 CARP Killinarden Mandatory urine screens for people in detention and/or Garda custody who claim they are in receipt of metha- done before receiving methadone.
Record keeping. For people in methadone treatment taken into custody a written record should be kept as to when they were taken into custody and when they requested methadone and when they receive it.
8 Irish Pharmacy
Union
Review of methadone supply to patients in Garda custody. Community pharmacists experience problems around the supply of methadone to patients in Garda custody. The guidelines around this are not straightforward and need to be reviewed immediately. When patients participating in the scheme are release there is currently no forewarning to the community pharmacist they regularly attend, which creates problems when trying to verify whether a dose was or was not given while in custody.
9 John Craven Dun Laoghaire Rathdown Local Drugs Task Force
Protocol should be extended to Garda stations to govern the administration or methadone to people in custody through a properly resourced forensic service.
17 OMD Protocol development needed. OMD supports the improvement to procedures in this regard. No guidelines are in place at present and we feel that there is a need to formulate a protocol with a view to maximising the chances for effective service provision, while minimising the risks involved.
29 HSE Addiction
Services Dublin North Central and Dublin North
National standardised protocols needed for doctors treating drug users in custody, outlining how to treat with- drawals, to induct on methadone and to prescribe an ongoing methadone maintenance programme. Stand- ardised training to accompany for all doctors attending Garda Stations. This needs to have a time defined for implementation.
CTL out of hours access. Doctors need access to central treatment list out of hours. 30 Soilse - Service
Users Presence of a doctors. At weekends there is no doctor available in some stations. You could sometimes wait up to 24hours. A doctor should be assigned to Garda stations in areas where there is high prevalence of drug use. A doctor should have access to records (on methadone or not).
Key workers. In the UK when someone is brought into custody and are addicted, a key worker is assigned to as- sess their mental state and to access methadone/access to a doctor arranged. This is done in the first hour of be- ing detained and before any interviews are done and is a confidential service. The same should occur in Ireland. Punitive use of methadone. In some stations, Garda hold your methadone use over you and use it as a threat. It is given at the Garda discretion. In some stations you are given 20mls to hold you.
31 SOILSE - Staff There should be a standard protocol for the prescribing of methadone for people arrested in gardaí stations. This must not be subject to abuse by the gardaí and should be overseen by the Ombudsman for the gardaí
34 McGarry House Garda training around methadone prescribing with procedures in place for those who are in methadone treat- ment if they are arrested needed.
37 Dr Declan O’Brien & Dr Don Coffey
Access to medication in Custody problematic. While the protocol was initially designed to allow the methadone follow the patient we are still finding that clients have problems accessing their medication in secondary care and while in Custody.
Liaison with Dept of Justice needs to be ongoing. We welcome the Prison Service policy of having Methadone available to prisoners, but methadone is still not available in all prisons. There are health and safety issues in giving methadone to those in short term Garda Custody, but those in custody longer than 24 hours should have access to their medications. Initiation of Methadone should generally not occur the acute arrest Situation
40 Irish Medical
Organisation
Clear guidance and training in the provision of treatment to opioid and other drug dependent people who are in Garda custody are essential.
The IMO is of the view that the establishment of a properly funded and staffed forensic medical services would be the most appropriate manner through which to deliver care to this vulnerable population.
43 Ballyfermot
Advance Dedicated ‘in-cell’ addiction workers need to be made available within the community that could be called upon, during arrest, to assist in addressing the needs of the individual in conjunction with the prescribing doctor.
46 Drug Treatment
Centre Board
Need for protocols and structures to be developed for methadone prescribing in Garda stations which are under- pinned by clear governance structures. In addiction clear procedures are training should be developed. Doctors providing this service should be Level 2 GPs and treatment carried out should be reported to the CTL.
82
Sub. ID
Source if
individual Organisation Submission
49 Dr Desmond
Crowley Protocol needed. A clear protocol should be established for the safe dispensing of Methadone to patients while in Garda custody. The same standards as the IPS services both of the continuation of MMT and for symptomatic opiate withdrawals.
Other meds. A perfect environment for suboxone or buprenorphine (which is much safer in overdose) and we should also review of the inappropriate prescribing of benzos, Librium and hypnotics in the management of pos- sible withdrawals.
50 Consultants
in Substance Misuse
Garda Doctor protocols and competences. Garda doctors need to have clear protocols in place for the provision of methadone to prisoners in custody. They should have specific training in Substance Misuse and consideration should be given to training up to a level 2 GP status. They should link in with ongoing CPD and training in the substance misuse services. Access to the Central Treatment list out of hours at weekends needs to be available.
51 Pharmacy Co-ordinators, HSE Dublin Mid-Leinster and Dublin North Central; and Primary Care Pharmacist, HSE North East
Lack of consistency in prescribing of methadone to patients in custody nationally. A national policy needs to be developed in conjunction with the Department of Justice and that direction is required to ensure safe provision of methadone in this instance.
GPs providing medical services through the Dept of Justice to patients in Garda custody should receive Level 2 GP training.
57 Tallaght Local
Drugs Task Force Enhance co-operation between relevant agencies - Gardai to be supported and facilitated in finding out whether a client is in treatment. Review methadone prescribing in custody for people with a heroin problem and/or on methadone
61 North Dublin
City and County Regional Drugs Task Force
Governance and clear policy required for methadone prescribing in Garda stations. Level 1 or 2 GPs required rather than GPs on duty at a particular time of intervention. Will clients be court ordered to attend stations for treatment? Stigma may be encountered.
65 Medical Staff
Committee, Addiction Ser- vices HSE Dublin North East
The Garda Siochana should adopt the policy of the Irish Prisons Service in relation to the safe prescribing of methadone for those who develop opiate withdrawal while in custody.
67 HSE Addiction
Services Medical Staff
Clear guidance and training in the provision of treatment to opioid and other drug dependent people who are in Garda custody are essential. In the absence of such a service GPs working for HSE Addiction Services would welcome the opportunity to provide input to the development of appropriate guidelines. We have developed draft guidelines in this regard.
A properly funded and staffed forensic medical service would be the most appropriate manner through which to deliver care to this vulnerable population.
69 Dept. of Justice and Law Reform
The treatment of persons detained in Garda custody is governed by the Criminal Justice Act 1984 (Treatment of Offenders in Custody in Garda Stations) Regulations 1987, as amended by SI No.641/2006); Regulation 21 addresses the issue of medical treatment. The operating premise is that the provision of medical treatment to a person in custody should, insofar as possible, be equivalent to that provided outside of custody with only those modifications necessitated by circumstances.
The Garda role in medical treatment of persons in custody is limited to: arranging treatment provision; recording certain matters and complying with instructions given by the doctor in relation to the care of that person. Any enquiries into the doctor/patient relationship by the Garda Siochana are kept to an absolute minimum. The practice is for each Garda Station that processes arrested/detained persons to have a list of GPs who can be requested to attend to persons in custody as required. Facilities are provided within each Station for the Doctor to administer the appropriate treatment in private.
It is not the role of the Garda Siochana to in any way regulate or control the clinical role of a doctor who is called to treat a person in custody.
The prescription of methadone to persons in Garda custody should be seen in this context. In the view of this Department is it a medical intervention similar to any other. Neither the Misuse of Drugs Regulations, 1998, nor the Methadone Treatment Protocol, appear to make exceptions for persons in Garda custody. The treat- ment for whatever medical condition is encountered in the context of Garda custody is a matter for the medical practitioner.