The methadone treatment programme for drug addicts, which has been in operation since 1998, is on the "point of collapse" in the Dublin area, the Irish Pharmaceutical Union (IPU) has warned.
The Irish Times has learned that individual pharmacists in the Dublin area have already begun sending patients back to central health board clinics in advance of possible official strike action by the IPU.
According to latest treatment figures, 6,886 people addicted to heroin and morphine are receiving treatment in the Republic. A total of 96 per cent of these are being treated in the Eastern Regional Health Authority (ERHA) area.
Pharmacists say the methadone treatment protocol is now unworkable because of a growing trend for health boards to refer "unstabilised methadone patients" to community pharmacies which they say is in breach of agreed conditions.
"There has been a gradual decline in management controls in the Dublin area," according to one pharmacist, "with patients turning up in a confrontational state at pharmacies following attendance at satellite clinics." He blamed constantly changing medical personnel and a lack of ongoing communication for the growing problem.
While many patients on long-term methadone therapy are stable, those who are beginning treatment or who have a separate psychiatric problem can be unstable leading to aggressive and violent behaviour.
Under the terms of the protocol which pharmacists signed up to six years ago, if a patient destabilises while on methadone treatment, he should be removed from the local pharmacists list. The 1998 protocol also states, "more difficult patients ... will not be dispensed methadone by community pharmacists but will be treated at a central level".
A number of pharmacists who spoke to The Irish Times claimed an increasing number of unstable methadone patients are being referred to them because of pressure from health boards. However, this was denied by spokesmen for both the northern area (NAHB) and south-western area (SWAHB) health boards of the ERHA.
Of 272 patients waiting for treatment in the region at the end of October 2003, 51 per cent are from SWAHB and 18 per cent from the NAHB. Eight per cent were waiting more than 12 months for treatment.
A further indication of the ongoing pressure for drug treatment places is the peak of 327 people who were waiting to enter the methadone programme in July last year.
A withdrawal from the methadone treatment programme by pharmacists in the Dublin area would lead to the effective collapse of the scheme - 64 per cent of participating pharmacies are in the ERHA, with only 104 based elsewhere in the State.
The IPU said that, because of local objections and the severe shortage of public funds, new clinics are prevented from opening in the Dublin area, leaving existing health board clinics overstretched.
It accepts that the majority of methadone patients cause no problem for pharmacists but that a minority of chaotic patients has "resulted in a significant rise in violent attacks against pharmacists and pharmacy staff".
These attacks have included needlestick injuries and gun attacks, pharmacists have reported.
A spokesman for the NAHB said it had "received no reports of complaints in its area of physical attacks on community pharmacists".
However, he acknowledged there were instances of verbal abuse and threatening behaviour. A SWAHB spokesman said it only placed "appropriate patients - those who are stabilised" with community pharmacists.
He said that in a situation where a patient relapsed "the board can act quickly to have that patient transferred back to a treatment centre".
A general practitioner who also provides a medical service at a satellite clinic said a possible solution to the problem may be to allow a health board pharmacist formally assess a patient prior to referral to a community pharmacist.
Dr Ide Delargy, Drug Misuse Programme director at the Irish College of General Practitioners, said recent research looking at the attitude of GPs in the programme had shown positive feedback.
"I am satisfied that GPs and pharmacists are working well together in the methadone programme."