The idea of providing a space where people can, under supervision, legally inject drugs would have until recently, it would be fair to say, alarmed a great many people. But attitudes may be changing. The Ana Liffy drug project and the Bar Council are right now working on draft legislation that would allow for the introduction of ‘medically supervised injection centres’ ( MSIC) and key figures such as the new lord Mayor Críona Ní Dhálaigh, are coming out in favour of such a move. It would seem that what was once beyond the pale might just be on the way. This would be a radical step, but what would it hope to achieve and it would it work?
There is a growing a concern with the level of open intravenous drug abuse use in Dublin city centre. This drug use is strongly linked to anti-social activity that comes in the form of open injecting, discarded needles and dealing. On top of this the death rate among Irish drug users is more than three times the European average. MISC’s are designed to tackle both of these problems. To reduce both the health risks to the user and lesson the public order problems that come with hard drugs. The user is provided with a safe space, clean needles, information about health care, and access to medical staff. More controversially they can consume their own drugs. On top of all this if something does go wrong, such as an overdose, the staff will be trained to deal with the situation.
The greatest concern to the wider community and what makes injection centres such a difficult sell politically is what’s often referred to as the honey pot fear. It’s the fear that drug addicts will be drawn to the centre’s and leave the surrounding community having to cope with an upsurge in anti-social activity. The drug services in Dublin city centre are widely believed to have acted as a magnet to addicts and contributed to anti-social activity in the city. In essence a more tolerant space draws in trouble.
Both the very real fear around the introduction of MSIC’s as well as the scale of anti- social behaviour that comes with hard drug use can be summed up by a message left in the comment section of the online paper ‘The Journal’ which ran a story titled. ‘Injection centres could soon arrive in Dublin- would you agree to that’
“I work on merchant’s quay. I’ve seen guys beat up their girlfriends, openly inject and deal, urinate and defecate on the street, harass people going about their day. I’ve been verbally abused, spat at and threatened with violence on a number of occasions as they seem to congregate directly outside the front entrance to the business and I have to ask them to move on. I try to have compassion but it is hard when you are putting up with this every day.”
This writer clearly connects his experiences to the drug services operating in the inner city and fears that MSIC’s could add fuel to the fire. Is he right to assume injection centres would further add to a troubled situation? Must the health of drug users and the well being of wider community always be at cross purposes? The only way to answer this is to examine how they have worked elsewhere.
MSIC’s are been increasingly used across the western world and are presently in operation in ten countries and 66 cities. When reviewed all these programs were found to have had a similar outcome. The most extensively studied treatment program is in the city of Vancouver in Canada with more than two dozen peer-reviewed studies published. These studies examined a whole range of variables. These included everything from cost effectiveness to treatment referrals. The facilities were found to have been successful in attracting at-risk populations, are associated with less risky behaviour, fewer overdose deaths and increased client enrolment in drug treatment services.
The downtown area of east Vancouver was a pioneer in this new approach to drug use and saw a 35% reduction in overdose deaths between 2001 and 2005.A survey of over 1000 people using the facilities found that 75% had changed the way they injected. 80% of those reported less rushed injecting. 71% indicated less outdoor injecting and 56% reported less safe syringe disposal.
Clearly MSIC’s have helped improve the health of drug users but what about the wider community? Do they lower anti-social activity or add to it?
Studies conducted in Germany and in Switzerland report a general reduction in the visibility and public nuisance associated with drug use. Studies conducted in the city of Vancouver consistently reported reduced nuisances associated with public injection. Study after study reached this same conclusion; none reported an increase in anti-social activity.
There is a false dichotomy at play. A belief that efforts to engage with the health of drug users and efforts to deal with public order must be at cross purposes. MSIC’s have been proven to kill two birds with one stone. Where ever they have operated they have been found to lower anti-social activity and to reduce the health risks to the user. There’s no reason to believe their introduction to Dublin city would be any different.
MSIC’s are not a solution to the drug problem and they should not be sold as such. They should form part of a harm reduction strategy. They work by removing one part of the drug user’s addiction cycle and taking it off the streets, the business of getting high. They don’t tackle the drugs trade, the scoring of drugs or the underling social and economic problems that contribute to high levels of hard drug use.
The only potential downside to MSIC’s is that they could serve to brush the problem of drug abuse under the carpet. It’s been estimated that roughly 30,000 Irish citizens are addicted to drugs and that raises a thorny question. Would this number have being allowed to grow so high if the Irish public really cared? The truth is that what’s driving the public appetite for injection centres has less to do with the health of addicts and more to do with their visibility.
MSIC’s should be part of a different approach to the drugs crises. An approach that accepts things as they really are rather than what many would want them to be, and that views the drug crises not as a war or a criminal matter, but as a public health issue. It accepts that people will, for a variety of reasons, use drugs and seeks to reduce the harm to the user as well as offer real and effective paths out of addiction. MSIC’s should be taken as one step in this direction and that step just might give us the confidence to keep on walking. We don’t want to look back in years to come and say that what we put out of sight, we put out of mind.
What’s your views on this debate?
The Author of this article does not necessarily represent the views of the organization.
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