'You have drugs going to the back-end of Mayo and the highest hill in Kerry'

Heroin abuse has been a problem in Irish cities for decades but has spread over the past 18 months to "seriously small" rural villages, where treatment services for addicts are hard to come by, writes CIAN TRAYNOR

GRÁINNE DIDN’T realised how bad her heroin problem was until she tried to hang herself. “Someone cut me down,” she says. “I wouldn’t be here if they hadn’t.” When she first saw her boyfriend heating heroin on a sheet of tinfoil and inhaling the fumes five years ago, Gráinne didn’t think it was any different from the other highs she had tried while working in bars around Westmeath.

“I’m from the countryside and because it was so quiet, I was a curious cat. That was me: I wanted to try anything.” At first it was their little secret. Even when Gráinne kept disappearing from her job as a manager at a cafe, no one suspected she was using.

“I was hiding it well,” she says. “Then I was sick one day and everything got on top of me. I handed in my notice because I could see myself getting really bad. The boss even cried, said I had a job there for life. That always sticks in my memory . . . but there’s no point in me getting a job until I can stay clean.”

Gráinne’s family – who she describes as old-fashioned – panicked. They tried locking her in a room, but quickly realised that wasn’t going to work. Eventually a friend convinced her to call into Open Door Mullingar, a community support service where she could come and go without judgment and without question.

Still, she needed convincing. Her scepticism subsided only when one of the counsellors, Mick Forde, helped her parents come to terms with her heroin problem. He assured them it was more common than they imagined, something Gráinne had been unable to do.

“It’s invisible to normal people who don’t do drugs, even in a small little village down the country,” says Gráinne, who is 26 years old. “They think it’s just in big towns.”

In his office above Open Door Mullingar, project manager James Hennessy points out a string of towns on a map of Westmeath: Castlepollard, Collinstown, Drumcree, Delvin, Rathconrath, Ballynacargy, Finnay. “Every single area you see on that map, there is someone on heroin,” he says.

Within a year, he hopes to have held drugs awareness campaigns in each place. Last month 300 people turned out for one such meeting in Mullingar, where they could see what heroin looked like or speak to AE and psychiatric consultants. Hennessy is full of praise for the local Garda Drug Unit but says there are spots around Mullingar guaranteed to have a dealer at certain times.

“This is not scaremongering,” he says. “You see it every day. Mullingar is no different from anywhere else. One of the key bases is colleges . . . That way you have drugs going to the back-end of Mayo and the highest hill in Kerry.”

Last week, Ireland’s heroin problem was listed as the worst in the EU. According to the 2010 annual report for the European Monitoring Centre for Drugs and Drug Addiction, an average of seven people in every 1,000 in the country qualify as opiate users.

“We’ve always had people with heroin problems,” says Willie Collins, addiction counsellor at Aiseiri Treatment Centre in Cahir, Tipperary. “But now we’re getting people from seriously small villages in country areas where you wouldn’t expect people to have anything other than alcohol. It seems to have spread into these areas in a significant way over the last year.”

One former patient of Collins was a tradesman in the building sector who ran a sideline in buying and supplying enough heroin for himself and five others, a typical arrangement, according to Collins. “People are supplying it to their cousins, uncles, nephews and nieces. It’s a network. It’s quite invisible but the consequences are visible.”

Accessibility, price and quality are the reasons heroin has spread to “all parts of Ireland” in the past 18 months, says Margaret Nash of Bushypark Addiction Treatment Centre in Ennis.

“It’s certainly emanating to rural parts of the region. Clients have said it’s easier to get heroin than any other drug. It’s increasing month by month. We’ve seen a jump of 15 per cent from last year’s figures and we expect a rise of 20 to 25 per cent for the coming year.”

The lack of a service in Westmeath providing methadone, a synthetic narcotic painkiller used to treat opiate addiction, means the HSE has to bus clients from Mullingar to the nearest programme in Athlone, where the waiting list for treatment can be between two and three years.

Places are in such demand that addicts with criminal records prefer to go back to jail, says Hennessy. “I know people who have broken their terms of release specifically to get back into prison to get on the methadone programme,” he says.

Even when a patient stabilises in a treatment clinic, methadone maintenance is often such a lengthy process that they need to be referred back to their general practitioner. That should be a straightforward process but the stigma for many GPs of treating addicts means many addicts get stuck at the clinic stage, creating a backlog, says Dr Graham Kearon, a GP in Athlone.

Gráinne had been waiting three years to get into the methadone programme in Athlone when she took things into her own hands last month. She began acquiring her own supply of methadone by travelling to Dublin and seeking out patients who were reducing their methadone and selling off what they didn’t need.

After a week of administering it herself, she struggled to cope with the headaches, anxiety and sweating that kicked in. Her boyfriend Darren, who first used heroin at the age of 13 and who has been on methadone for the past year, assured her it was a sign of the heroin finally leaving her system. “I didn’t feel too clean,” she says. “I’d been in a bubble for so many years that the body was clear but the head was still confused.”

Gradually she reduced her intake to 10mg per day, then five, before reducing to nothing at all for one week, although the pains in her stomach were so bad she has returned to taking 2mg per day.

She has since been granted a place on the methadone programme in Athlone, which she decided to take as she fears relapsing if left to acquire the methadone herself. She has to give a urine sample twice a week and if it’s “dirty”, she’ll be kicked off the programme, which allows her to get methadone from a pharmacy each day.

“I’m trying to be good,” she says. “It’ll still be a long process but I’m in a better place. My mam even gave me a big hug and said, ‘I don’t care if you take that medicine for the rest of your life; you’re back to yourself. You’re not depressed.’”

Gráinne is still calling in to Open Door Mullingar, which has helped her build a new social circle that’s supportive rather than destructive. She says she will never feel truly clean until she can move away from everyone associated with her time as an addict, but she can’t afford to do that at the moment. “Heroin will always follow you,” she says. “But I think I’m slightly different because I want a family. That’s my goal and by Jesus, I will have a family.”

'The services outside of Dublin are fairly spartan'

According to the HSE, there is currently a combined waiting list of roughly 600 people seeking methadone treatment throughout the country, around 5 per cent of all patients in treatment. However, the Health Research Board claims this accounts for only 55 per cent of all opiate users in Ireland.

There are 69 HSE clinics operating throughout the country; 53 of those are in Dublin, four are in Wicklow, and just one each in counties Cork, Limerick, Westmeath, Galway, Laois, Kildare, Kerry and Waterford. This is despite the fact that roughly one-third of the 3,893 new cases presenting with opiate addictions between 2004 and 2008 (the most recent figures available) came from outside the Dublin, Wicklow and Kildare areas.

People living in Dublin experience an average wait of between two weeks and six months for methadone treatment, whereas those living outside Dublin wait between one month and two years, depending on where they live.

"The services outside of Dublin are fairly spartan," says Tony Geoghegan, chief executive of Merchants Quay Ireland and deputy chair of the Midland Regional Drugs Task Force.

"The more social services there are in place, the more people come out of the woodwork to access them. But there has been no incentive to go out looking for services because there is none there. If someone looks for a methadone programme [in the midlands], there's a year or two-year waiting list and therefore no incentive to put themselves forward."

A spokeswoman for the HSE said additional services in Wexford, Waterford, Kilkenny, Tralee, Limerick city, Drogheda and Dundalk will be in place before the end of 2010. The HSE is also planning clinics in Gorey and Cork city and is sourcing facilities in the midlands to provide two additional methadone clinics to address waiting lists there.