As Fine Gael’s Catherine Byrne TD gets to grips with her new Minister For Drugs brief, we bring her predecessor Senator Aodhán Ó Ríordáin of the Labour Party together with four experts to decide how Ireland’s chronic heroin problem can best be tackled.
If a reminder of Ireland’s chronic heroin problem were needed, it came in April when two Dublin men overdosed within both days, and metres, of one another.
The first, aged 42, was found outside an apartment complex on Foley Street where it’s believed he’d lain dead for several days. The second victim, aged 33, was discovered in the toilets of nearby Connolly Station with a syringe next to him.
Depressing but not surprising. Taken on urban safari before Christmas by Ana Liffey Drug Project Director, Tony Duffin, who estimates that 400 Dubliners are injecting publically, we found needles, syringes, wraps, wipes and other heroin paraphernalia on every city centre street, including within yards of Dáil Éireann.
Published last week and drawing on 2014 data, the European Monitoring Centre For Drugs & Drug Addiction Report reveals 1,036 people entering into opiate treatment for the first time; 9,764 receiving methadone and other on-going substitution treatment; 25 new cases of HIV attributable to injecting drug use; 954 police seizures yielding 61kg of heroin and, most crucially, 214 drug-induced deaths. Alternative Health Research Board data puts the figure even higher at 387.
Both sets of stats will doubtless have been studied by the new Minister of State for Communities and National Drug Strategy, Catherine Byrne, who last year backed her predecessor Aodhán Ó Ríordáin’s plans for a medically supervised injecting room in the capital.
“It would provide a legal, safe and sanitised environment for drug users to inject,” the Fine Gael TD for Dublin South-Central said. “It takes the problem off the streets and away from the public who really should not have to see people injecting drugs as they go about their daily business.”
Whilst proven to have saved lives in countries like Australia, Canada, Germany and Spain, where they’re already up and running, supervised injecting centres alone won’t solve our addiction problems. With this in mind, Hot Press brought together five key stakeholders for a Heroin Think Tank, which we feel is another must-read for Minister Byrne...
Sat around the table are:
Aodhán Ó Ríordáin – Whilst no longer in government or the Dáil, his election to the Seanad means that nuanced debate of the drugs issue in the second chamber is assured.
Tony Duffin – the aforementioned Ana Liffey Drug Project man briefed Aodhán whilst he was a minister, and will be tendering to run Dublin’s medically supervised injecting centre if and when it’s green-lit.
Dr. Garrett McGovern – a Dublin GP specialising in alcohol and substance abuse, who backed Luke ‘Ming’ Flanagan’s Cannabis Regulation Bill.
Anna Quigley – coordinator of CityWide, a Dublin agency that delivers support to community groups, projects and activists working locally on
drugs issues.
Dr. Cathal Ó Súilleabháin – the HSE East Coast GP Coordinator for Addiction Services, who has also campaigned for a major overhaul of Ireland’s drug laws.
Stuart Clark – the Hot Press Assistant Editor who’s Jeremy Paxman for the day...
Stuart: Aodhán, we were worried for a while that there wouldn’t be someone taking over your brief, but Enda has finally given the gig to Catherine Byrne who was Fine Gael’s deputy Drugs Strategy spokesperson in opposition and therefore knows the terrain. What should she expect from the job?
Aodhán: My first day in the Department of Health, I was getting a lift up to my office – which they used for yoga on Thursday by the way! I went to peer through the window and they were like, “No, don’t look out!” I asked “Why?” and they said, “Because they shoot up out there.” And they do, right in the shadow of the Department of Health. I knew I had less than a year, so I had to pick my battles. I was also Minister for Equality and all the groups I was dealing with – disabilities, LGBT, migrants – have disproportionately high substance abuse problems, because they’re disconnected from mainstream society.
Stuart: Which says what?
Aodhán: It’s about the conditions in which people live, and the fact that we have collectively dehumanised the addict. When those deaths happened at Connolly Station and Foley Street, both apparently from overdoses, there was no vigil, no protest, no Dáil questions, nothing. There’s a victim-blaming approach in that, at some level, it’s his or her own fault. People talk about the ‘n’-word but we also need to get away from using the ‘j’-word, junkie.
Tony: I would hope that she would pick up on all that. I don’t want this to turn into a love-in (laughs) but we were constantly asking for leadership and finally got it when you became minister, Aodhán: It’s a politically uncertain time, so I would ask the new minister to set herself achievable goals like getting the supervised injecting facility over the line and continuing the discussion on decimalisation, which so many groups want to see progressed.
Stuart: Where precisely were you with the legislation when the election was called?
Aodhán: It had been passed by cabinet, and once it’s passed by cabinet the argument is over, the discussion has been had; or at least in theory it has. We’re now in a new political situation, and not every piece of government legislation is going to go through the house when the numbers are so small. It’s accepted across the political spectrum that it’s a good thing. I remember being at a Families Network meeting and from the Sinn Féin Education Spokesman, John O’Brien, to Paschal Donoghue and David Stanton, there was agreement on the issue.
Stuart: So what might go wrong?
Aodhán: The two possible sticking points are, “Is there time and space within the Oireachtas calendar to push it through?” and, “Once the framework’s changed, will there be money in the budget for a medical injecting facility?” It is in the Programme for Government, though, which makes it more difficult for them to do a U-turn on it.
Stuart: Tony, you’ve crunched the numbers; how much would it cost to run?
Tony: For a 12-hour day, seven days a week, year-round centre, you’re looking at €1.5 million. It’s a lot of money for you and I, but for a country it’s not. The Canadian and Australian experiences are that it’ll save money beyond what you spend and, most importantly, save lives.
Anna: The injecting rooms are recognising that there’s a group of people in this city for whom existing services are not meeting their needs. Not everyone requires injecting rooms – we have a range of different types of drug problems and programmes.
Stuart: Unless you lied at the job interview, I assume that Enda knew he was appointing someone who was going to advocate a move towards the Portuguese “treat rather than punish” model?
Aodhán: Yes, he did. The Justice Committee has already come to a consensus on decriminalisation and been to Portugal to look at those models. The injection centre has been the focus of media interest, but there are lots of other things happening – such as why is someone travelling up and down to Dublin from Portalaoise on a bus to go to Trinity Court? Why can’t they be treated in their own town? The fact is that if you have a methadone centre in a community, you’ll get residents who are not happy about it.
Garrett: People outside of Dublin can’t get methadone treatment, and some will invariably die because of that.
Cathal: I’m the East Coast Coordinator For Addiction Services. We have a clinic in Arklow, which is sort of the last outpost before Dublin. There are areas further south that are full of heroin, so naturally enough people come up to Arklow, sit on the wall outside and attempt to buy methadone from our clients. The people of Arklow say, “Look, we told you so, you’re attracting addicts.” So I’ve offered to go down to places like Gorey and Portlaoise, which have major problems, and prescribe. If the HSE provides us with the space, I could have a team of doctors down there within weeks – but there’s no budget.
Garrett: To access methadone treatment we’re meant to get three urine samples that show you’re off heroin, which costs (the HSE) something like €5 million a year to process. First of all, you shouldn’t be turning people away who clearly need treatment and, secondly, swab samples are much cheaper. There are people working in the addiction services whose role is to watch a person urinate which I feel is unethical. It’s a human rights violation. Every other country in Europe has switched to a swab system.
Anna: It should be the same as any other medical treatment, but it’s not. Instead, we’re saying, “You’re doing something wrong, so it’s okay to degrade you.”
Aodhán: If people with other medical conditions were treated like that, they’d be onto their local TDs or the media saying, “This is outrageous!” You’d have whole radio shows devoted to it, but the system has made them feel like criminals, who don’t deserve any better. We have to change that.
Stuart: Is there any way you could make it part of a GP’s duties to prescribe?
Ann: They’re all private, aren’t they?
Cathal: It’s not just that. GPs are overwhelmed.
Garrett: There’s no governance in the addiction services at the moment. It’s chaos.
Stuart: Surely it’s up to the medical profession to change that?
Garrett: One of the problems, if you look at all the drug committees, is that, from the beginning of time, it’s always the same people – who often have very entrenched positions. There are a lot of doctors, for instance, who don’t agree with drug decriminaslisation. I gave a talk on methadone to some doctors and one woman actually called me a drug dealer. Another was really nasty about methadone. The vibe in the room was that, “Drugs are evil, the people who take them are evil and the people who prescribe them are evil.” Heroin, methadone, opiates and injecting rooms are all demonised. It annoys me when medical professionals say that I’m soft on drugs just because I believe in decriminalisation and putting people through the health system as opposed to the court system. I’m actually less tolerant than them, in that I won’t accept people shooting up on the street.
Anna: I think we tend to over-focus on methadone. I understand why: it stops people dying. But some of them have been on it for 16 years and not progressed. That’s not an argument against methadone, but it shouldn’t be regarded as a permanent solution.
Tony: It’s important that methadone is delivered across the country, but we also need other treatments.
Cathal: There’s a small group of around 150 people working in addiction in Ireland. They all come from the same source, Trinity Court. When I started working there, after I’d come back from Canada in 1984, I went to the senior registrar, who was sat there feet-up with the Irish Times chainsmoking and said, “You’re going to tell me what to do, aren’t you?” My ‘training’ turned out to be him ripping a page from a book and saying, “That’s what you do.”
Stuart: So where did you learn?
Cathal: It was the nurses who showed me what to do. I think Garrett is one of the very few people in Ireland with a post-graduate degree in addiction.
Garrett: Buprenorphine is a really good drug that’s widely used in other countries, but has basically been blocked here by psychiatrists, who either don’t know about or choose to ignore its effectiveness. The reason the training is poor is that it was considered the basement bucket of medicine. People tend to look at the quantity rather than the quality of treatment services. I’ve seen how some of those places operate and how patients are treated. Some of the people treating them and writing prescriptions have no training. People are being referred to places like this from the courts services. There’s a disempowerment of the clientele, which the new minister has to address.
Anna: It’s a massive class thing. There are people taking heroin who are middle and upper class, but they’re not who you see on the streets. The heroin problem emerged in disadvantaged communities and, regardless of the accuracy, we perceive addicts to be dangerous and inferior and not worthy of public resources. What enables that to continue is the absolute refusal in Ireland to acknowledge that alcohol is a drug. Most people drink and don’t develop a serious problem, but if they do, we treat it as a health issue. We have to stop treating heroin service users as if they’re criminals. The majority of people take heroin because they’re in emotional pain – pain that’s more often than not associated with their living conditions. Magically take the heroin addiction away and there’s still a problem with housing, jobs, amenties etc. etc. You can’t tackle one without tackling the other.
Aodhán: It’s the anniversary of marriage equality; we talk, rightly, about LGBT rights – but what about the rights of those with addictions, many of whom are on the bottom rung of the ladder in terms of empowerment? There’s a cosy fashionability about certain equality issues, whereas others like advocating for the Roma community, direct provision for travellers and migrants – or whatever – don’t make for very good photoshoot opportunities.
Stuart: So what can be done about that?
Aodhán: We had a nuanced debate about marriage equality, which went beyond Twitter soundbites. Let us now have a nuanced debate about this, which avoids stereotypes and allows service users to be heard. Reforming our drug laws is every bit as important as repealing the 8th.