For years the biggest obstacle to the provision of drug treatment services was either official neglect or a lack of funding. Now it seems it is the "not-in-my-backyard" attitude.
Disputes with residents' and business groups have effectively brought the Eastern Health Board's treatment expansion plan to a standstill.
While the number of drug treatment places almost doubled between 1996 and 1998 from 1,861 to 3,610, only 128 new places have been created in the past six months. More worryingly, after a decline in the number of people on waiting-lists from 560 to 455, the numbers have since risen to 478 (143 women and 335 men).
The increase in local resistance has coincided with an attempt to move services away from over-stretched city-centre clinics to the suburbs. Persuading residents in often affluent areas that, first, they have a drugs problem in their midst and, second, it needs dealing with is proving a difficult task, with the hardest battles being fought in south Dublin.
Plans to establish a clinic on the grounds of the EHB's health centre at Old County Road, Crumlin, have been blocked by South Dublin County Council after strenuous lobbying from residents' groups.
Providing a comprehensive range of services from methadone maintenance to education and family support, it would be Dublin's 10th addiction centre and, excluding the city area, only the second in south Dublin.
The area's other such centre, Dun Laoghaire, is meanwhile embroiled in its own controversy. Businesses located near the Patrick Street clinic are calling for its closure, citing an increase in "street-fighting, drugs-trading, assaults and shoplifting".
Meanwhile, attempts to establish satellite clinics - 36 of which are operating in Dublin - which would be linked to the Dun Laoghaire addiction centre have been thwarted. Having dropped plans to develop three clinics at Shankill, Ballybrack and Loughlinstown after local opposition, the health board has opted for a single facility at St Columcille's Hospital, only to find itself embroiled in another dispute with residents threatening "direct action" to stop the development.
The health board has attempted to ease fears by making security a priority at clinics and emphasising the strictness of its monitoring policy. Supervised urine samples are taken every day from patients who are allowed to drink the heroin-substitute methadone only in the presence of medical staff at the clinic.
The EHB also argues that the services can help to reduce crime rates and unsociable behaviour, creating a "win-win" situation for the local community.
Such claims are supported by Garda figures, with Dun Laoghaire recording a 10 per cent drop in crime in the first year after the clinic opened, in April 1997, and a 20 per cent drop the following year. Insp Liam Mulcahy, of Dun Laoghaire station, says: "The drug clinic has made a definite contribution towards reducing crime, especially larceny."
However, Mr Vincent MacDowell, chairman of the Dun Laoghaire Business Association, says this does not tally with the experience of local shopkeepers. "There has been an increase in fighting in the street, an increase in dealing." The health board's security assurances, he adds, are "absolute balderdash. Security is a farce".
Mr MacDowell, a Green Party councillor who owns a pet and craft shop in Patrick Street, says his objection is not out of self-interest. "What we are trying to put across is that the clinic should be located in a more discreet area, not in the middle of the commercial heart of the town."
He claims that more than 140 patients are being treated at the centre in contravention of an agreement to cap the numbers at 100. According to the health board, the total is just 96.
The board has also agreed to close the facility at weekends, acceding to a demand of the association, even though it detracts from the quality of treatment offered. Dun Laoghaire is the only addiction centre operating on a five-day basis, requiring patients to administer "takeaway" doses of methadone themselves for the other two days.
However, the local chamber of commerce does concur with the association. Its president, Mr Tom Nolan, says most people acknowledge the need for the clinic, although he says it should be used only by local addicts and contain a broader range of rehabilitation services.
If there is a problem with excessive numbers of people attending the unit, it is partly due to local opposition elsewhere. At least 27 Dun Laoghaire patients are due to be moved to the proposed Loughlinstown clinic along with 25 new patients currently on waiting lists.
The row over this satellite clinic reached new heights in the run-up to the local elections last month when a local Fianna Fail councillor, Mr Larry Bulter, who favours the plan, was targeted by the Loughlinstown Action Group. After accusing the group of "pushing" the other three-clinic proposal, Mr Bulter found himself the subject of angry protests at polling stations.
In a letter to the EHB recently, the group warned that if it decided to go ahead "and visit this plague
on this community, it will be revisited back on them twofold". It suggested it would lobby "on a daily basis anyone within the EHB and the political parties who we feel is responsible for locating, operating or supporting this action", making it "a 24-hour issue for all involved".
A spokesman for the health board says it gives "very careful consideration" to such local concerns, adding that in most cases opposition can be overcome.
The Cork Street addiction centre, for example, had a tortuous birth but is now regarded as an integral part of the community.
Mr Charlie Hammond, chairman of the local residents' association, says: "All the fears we had of dealers hanging about and people shooting up outside, thankfully, have not materialised." Instead, there has been a noticeable decrease in crime.
The EHB spokesman says it would like to have more co-operation than conflict with local communities and "to introduce these services in as pleasant a way as possible". However, "at the end of the day, we have an obligation to provide the services and we will do so".
This was all the more urgent, he says, as "if there are 500 people on the waiting-lists you can take it there are probably double or treble that number out there who need treatment."