DOCTORS AT THE Irish Medical Organisation (IMO) AGM have spoken about the difficulties they face when treating people who are using illegal substances.
Dr Matthew Sadlier proposed a motion at the conference which would have seen the IMO call on the justice and health ministers, along with the Medical Council, to clarify doctors’ legal responsibilities in relation to reporting the use and sale of illegal substances.
Sadlier stressed he wasn’t necessarily on either side of the argument but felt the issue needed to be debated as many medical professionals are unsure of what to do when such a situation arises.
The consultant psychiatrist noted that drug dealing happens in mental health facilities throughout the country, a somewhat inevitable offshoot of treating people with substance abuse issues.
A number of contributors opposed the motion, saying they understood why it was being proposed, but, if enacted, could put vulnerable people off seeking help.
One doctor said patients in mental health or drug detox facilities sometimes make up information about other patients in a bid to get them in trouble, so not everything could or should be reported.
He said doctors should decide themselves if they need to report something, namely if they believe someone is genuinely at risk.
Ultimately, the motion was rejected.
Injection centres and medicinal cannabis
Dr Garrett McGovern proposed a motion calling for the IMO to endorse supervised injection centres, due to the evidence they reduce overdose deaths, drug paraphernalia litter and the number of ambulance call-outs.
Some concerns were raised about the issue from the floor but most people agreed that international research highlights the positive benefits of such centres, and the motion was passed.
Medicinal cannabis was also on the agenda, with Dr Cathal Ó Súilleabháin proposing that the IMO urge the government to “not limit the availability of medicinal cannabis products in any future legislation by restricting their prescription to consultants and the indications for which they can be prescribed”.
Ó Súilleabháin, a GP in addiction services, took issue with the fact chronic pain is not one of the conditions for which medicinal cannabis could be prescribed under legislation currently being debated in the Oireachtas.
“One of the biggest things medicinal cannabis works for is chronic pain,” he noted.
Ó Súilleabháin said he believes the government does not want the bill to pass and will put too many restrictions on the use of medicinal cannabis.
A number of doctors contributed to the debate saying the approach to medicinal cannabis must be evidence-based and have some restrictions, noting it can be a potent drug.
A Health Products Regulatory Authority (HPRA) report recommended in February that medicinal cannabis be made available to people with certain medical conditions, namely:
Chronic pain was not included on the list.
Speaking about the HPRA report in the Dáil recently, Health Minister Simon Harris said: “Patients accessing cannabis through the programme will be under the care of a medical consultant.
“The HPRA report did not recommend the inclusion of chronic pain and spasticity from cerebral palsy conditions for cannabis-based treatments in the access programme.
“However, this position will be kept under review, and if better clinical evidence becomes available in future, the inclusion of these conditions can be reconsidered.”
Drink driving
Delegates also backed a motion calling for the government to legislate for an automatic ban from driving, “of appropriate duration”, for anyone convicted of drink driving offences, including first time offenders.
Proposing the motion on behalf of the IMO Council, Dr Patrick O’Sullivan said: “There should be a zero tolerance nationally on drink driving and an automatic ban on those caught.”
The motion was passed unanimously.
The discussion was timely given the fact legislation proposed by Transport Minister Shane Ross would mean anyone caught driving over the legal alcohol limit would get a minimum three-month ban.
‘Dying for investment’
The overall theme of the conference was ’Dying for investment’, with a number of speakers highlighting the need for extra resources and staff.
Dr Brian Turner, a health economist based at University College Cork, told delegates Ireland needs 2,800 extra doctors and 9,000 additional hospital beds to match OECD average figures.
He said the Irish health system has not fully recovered from cutbacks made in the 1980s and ’90s.
Speaking to TheJournal.ie at the AGM, incoming IMO President Dr Ann Hogan said: “We need a massive investment in our health service.
We see how the health service has suffered after all the years of austerity … we have hospitals that just can’t cope, you go into an A&E and you could be there for days on a trolley waiting. We see long, long waiting lists for necessary surgical procedures like scoliosis procedures.
“I suppose our problem in some cases in this country is that we have had trouble recruiting people into critical posts because so many of our young health professionals are planning to go away and stay away … because work and conditions here are so poor and people can earn a lot more in other countries in settings that are an awful lot more conducive to their work and development.”
Hogan said we urgently need to invest in services and improve working conditions in order to get more doctors to stay in Ireland.
When asked about a possible restructuring of how money is spent in the HSE, Hogan said: “There’s a lot of sweeping statements made about some things, but obviously the health service does need to have managers and administrators.
“People will say, ‘Oh there’s too many people working in there’, but at the same time, when they ring up with their query, they want someone to answer the phone and be able to deal with their query.
We need to try and achieve a happy balance where we have enough people in management and administration, behind the scenes stuff. For every new consultant you employ, you do need someone to type up their letters, to make sure their appointments get sorted, all those kind of things.
‘An explosion in theatre capacity’
Speaking at the conference, Hogan’s predecessor Dr John Duddy expressed concerns over the work of the Oireachtas Committee on the Future of Healthcare.
He said the committee made a fundamental error by deciding to not cost its recommendations.
“While the notion of mapping out a 10-year strategy for healthcare is admirable, doing so without paying any attention to the resource issue is just meaningless and has significantly undermined the value of the exercise.”
Duddy said the IMO is concerned at recent leaks of the committee’s likely recommendations, stating: “While we will have to await the final publication of the report, what we are hearing so far is far from encouraging.”
He cited in particular the risk with rumoured proposals to legislate in order to oblige hospitals to perform within set times, saying this was impractical.
You can’t even begin to deliver on this proposal without an explosion in theatre capacity in this country. Even if all operating theatres were opened and fully staffed next week, it could not happen.
“There simply isn’t the physical space in operating theatres or surgical wards to cater for all the patients who would require surgery in this timeframe.
“If hospitals are fined or punished for failing to meet this target, it will have a negative impact on the whole hospital. This kind of target-driven culture will not help patients, and could ultimately harm them,” Duddy said.
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