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A motion stating that all Opioid treatment guidelines proposed as National Guidelines should be peer reviewed and validated by the National Clinical Effectiveness Committee (NCEC) was passed at the IMO AGM last week.

The motion was proposed by Dr Cathal Ó Súilliobháin, a member of the IMO GP Committee and a leading drug treatment expert, who said that there was a dark history of drug treatment guidelines in Ireland starting with the 2008 ICGP version that was extensively changed before publication without the knowledge of Guideline Development Group (GDG) members. He said the changes were explained by the ICGP CEO at the time as “an administrative error in the final editing process.”

Following this, two external reviews of drug services in Ireland recommended new Opioid guidelines, Prof. Michael Farrell (2010) and Dr Sekat Pryardarchi (2012), head of Glasgow Drug Services. Both reports also recommended inclusive representation on the GDG.The HSE has recently circulated “Clinical Guidelines for Opioid Substitution Treatment” after over five years of deliberation by a GDG whose membership has not been revealed but was restricted by HSE management.

A group of 33 doctors working in addiction, a substantial percentage of those working in the field, requested representation on the GDG and were refused. A number of doctors working in addiction have expressed patient safety concerns regarding the new guidelines. The HSE however, has refused to have these new guidelines peer reviewed or submitted to the NCEC for scrutiny. Dr Ó Súilliobháin explained that this could have serious implications for doctors treating patients with addiction problems as they are subject to audit. If the criteria used for these audits are not evidence based and properly validated then it could lead to patients receiving suboptimal care. The issue of evidence-based practice was raised in a number of other discussions on motions regarding drug issues.

A motion was also passed by the meeting urging the government not to limit the availability of medicinal cannabis in any future legislation by restricting the indications for which it can be prescribed or limiting its prescription to consultants only. Dr Ó Súilliobháin agreed to a suggested amendment requiring all indications for medicinal cannabis products  to be evidence based and held to the same standards as any other medication in this regard.