Crack cocaine in the Dublin region - Health Research Board

• more outreach work to identify crack users and encourage them into treatment(seven services);• additional crack-specific training to augment existing core skills (six services);• quicker access to psychiatric services in the case of high-risk patients (threeservices);• the promotion of harm reduction, such as safe crack pipes (three services).9.6 Treating polydrug useAs Section 5 indicated, the majority of treatment services’ clients who present reportingcrack use are polydrug users with a history of opiate dependence in particular. Crack isone of many drugs they may be using along with heroin, methadone, benzodiazepinesand alcohol. Two services argued that services should be geared towards polydruguse and treat all drug misuse rather than setting up structures for one particular drug.Five non-medical services referred to the challenge of treating polydrug use, and someexpressed concerns about the approach of methadone clinics to crack. In particular,these services felt that service providers were ignoring clients’ polydrug use:One person [crack-using client] is on heroin and crack and a few others would be onmethadone…the majority would be [on] methadone, they’re in clinics [where] they are gettingtested, supposedly getting tested for urines but ... are getting away with giving dirty urines orthey are now getting someone else to give urines for them. I don’t know, they could be usingbogey urines. I don’t know how that works. We wouldn’t have that many links in that waywith clinics and it’s probably better for it because if you started kind of linking in with clinicsand saying this person is presenting and he’s using crack and he’s still on the methadone itwould probably upset the clinic a bit I would say – so we tend not to go there.Finglas, drug-treatment service (October 2007)You know I don’t think clinics are helping. And when I say that you know people that arepolydrug using and I know one person at this present time who is injecting coke. Her familyhave rang the doctor. And methadone still hasn’t been reduced. You know and they tell youwhy they are using methadone because they are being treated for heroin dependency. Whyleave her on the same dosage if she is going to put cocaine into her?south inner city, drug-treatment service (September 2007)Oh God I really, really don’t know. You see we haven’t really tackled the other issues yet.Even though we’re saying we have but we haven’t. It’s very hard to move on to, and again,no criticism, nothing personal against the staff or I really think the health board need to sitdown and revise the satellite clinics. And the clinics in relation to the heroin addiction withthe methadone, like, we haven’t got that right if you know what I mean. I know there’s thebenefits, the positives, it cuts the crime rate down and all that but I don’t know, I really don’tknow because, as I said, most of them like what they do.north-east Dublin, drug-treatment service (October 2007)98 Crack cocaine in the Dublin region: an evidence base for a crack cocaine strategy